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WATER / SEWER UTILITY APPLICATION <br />-.• . CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ����� '� S <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everet[eps(�everettwa.gov � www.everetriva gov/permits <br />ADDRESS: <br />APPLICABLE: <br />IILDING TVPE: <br />OF USE? <br />PROJECT SITE INFORMATION <br />� <br />O OUTSIDE CI1Y LiMITS ❑ BUILDING AREA SF ❑ LOT #_ <br />❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑IdULTI�FAMILY-# OF UNITS_ ❑COMMERCV!L ❑INDUSTR�AL <br />� NO � YES. FROM _ TO <br />UTILITY AI' PLICATION INFORMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />SIDE SEWER REPAIR <br />❑ SIDE SEWER ALTERATION <br />❑ NEW SIDE SEWER INSTALIATION <br />❑ INSTALL BACKWATER VAL' '� outvde the building) <br />❑ SIDE SEWER CAP-OFF <br />AULTIPLE DOMESTIC WATER SERVICES RE�UEST <br />❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR <br />MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP <br />❑ I AM OPTING TO INSTALL MULTIPIE DOMESTIC WATER <br />SERVICES FOR MY MULTI-FAMILY DEVELOPMENT U!JDER <br />SINGLE OWNERSHIP, FILL OUT REVERSE SIDE OF THIS FORM. <br />❑ NEW WATER SERVICE INSTALLATION <br />❑ COMPLETE SERVICE ❑ METER ONLY <br />SERVICE I MET' R USE. <br />❑ SFR <br />❑ MULTI-FAMILY - # OF UNIT:�•-_ <br />❑ COMMERCIAL <br />WATER SERVICE TYPE / SIZE: (circle aes�red size) <br />❑ DOMESTIC 3/4", 1", 2", <br />❑ IRRIGATION: 3l4", 1", 2", <br />❑ FIRE�. i", :', 4", 6", 8", <br />D DOMESTIGFIRE COMBO: 7'. 2'. <br />OTHER <br />OTHER. <br />OTHER: <br />OTHER: <br />AGREEMENT The untlers+g�ed appbcan! ag�ees (o compiy �v�tb allpronvons ol (he Ereretl Muniopal Code Tdle <br />ta Waler antl Sewer orsuch other Nles and iegulalions now eaisfing or wnich may De eslaGbshetl Irom Gnw �o <br />bme 70e aOPGcant lurtner a9�ees, as a contlmon precetlent Io receiving service Ma! fhe ufArties tlins�on snall nave <br />fhe ngM at any fime. wrthouf notrce. Io s�ul o!!c�lum an the wafersupply /or repairs, conslruchon, an0 <br />nonpaymenf o�c�arges o� lar any ofhe� reasonaU!e cause. I am I�e owner. or 1 am aufDonzeO Dy fhe ownei olthis <br />propertylc perfmm 1he wod tor whi applicanon is matle, and I compry wiN t�e S�afe Confreclors Law 78.27 <br />RCW and 296 200A WAq � �—��� <br />vate <br />Gfy o/ Evereff OlGdal Use Only <br />FEE nD QO <br />'� / <br />PERMIT # %%/�/�/� <br />U 1� 2r VV ` <br />(Rev�setl 10/f7/POt5J <br />