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Multiple Domestic Water Service Request Form <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 — www.everettwa.org <br />C� - b aolS <br />Date <br />F e+-n �- o, A 3 a804o10o4 03�-i o0 <br />PR�HOjJECT ADDRESS (Please attach site plan with proposed water services shown) rAX PARCEL NO. <br />cy-0c &r } � �fa�} 1-1611'�eS <br />Property Owner <br />Mail Address f ''7 <br />city state zip <br />�ve�� ��cLc�c�:`jrolttr✓�S. ctJl't') .4125-2J() y L y <br />EE • i�s Phone Number <br />Number of Services Requested: <br />X-3/4a X-1'Lk-2f <br />EMC 14.16.430 Single and multiple metered services —Regulations and charges. <br />Only one metered service connection shall normally be installed to a premises under single ownership. If, however, a consumer <br />shall request that more than one metered service be connected to a premises under single ownership and the superintendent <br />shall agree that the particular individual circumstances warrant such additional connection(s), the party requesting same shall <br />make application and payment in the regular manner and such additional connections) shall be considered to be solely for the <br />benefit and convenience of the applicant. The premises shall thereafter be charged for water service through each service <br />connection independently as though service were being provided to two or more premises, and the minimum charge and 1 <br />charge for water consumed shall be computed separately for each metered service: provided that the premises shall remain <br />liable for a lien for water charges as provided in Section 14.16.050. (Ord 1237-86 § 43, 1986) <br />1 hereby consent to the terms of EMC 14.16 430listed above: <br />rN <br />\Z I(, - -I <br />Ap ican gnaturo <br />Date <br />Office Use Only <br />Approved by: <br />.:I� av� <br />thodzed Signature Date;, <br />HtVI$EiJ 11/1470r4 <br />