Laserfiche WebLink
WATER / SEWER UTILITY APPLIGATIOIv <br />r_i rv or Ev�Rrr�r r��=F����rr sERv�cFs <br />3200 CEDAf� STRF� 1, f_V�R'tTT, WA 98'1_0? <br />(P� �:75-7_6l-H810 � FAX 425-?57-8£357 �(E) everetleps@evere'iwa ga� � www everethva yov/pennds <br />PROJECT SITE INFORMATION <br />;aecr noorzess: / <br />APPLICABLG: OUTSIDE CITY LIV:1 S ❑ BUILDINGl�f2GA_ SF ❑ 10T�_._ <br />IILDINGTYPE: ❑SFR-0ETACHED �;FF?-%��"i�CtiEC ❑DUI�X �M11111J6FAHILY- O� UtJITS ❑CO'�9tALRCi�L ❑WCLISTRIAL <br />IANG[ OF USE? � h0 ❑ YF ;, f"ROiul TO <br />' UTILIT'Y APPLICATION ID�FORMATION <br />SEWER (cneck all that apply) WA7ER (r.heck all that applyj __ <br />❑ SIDE SEWER REPAIR <br />❑ SIDE SEW[R ALTERATION <br />❑ NEW SIDE SEWER IN57ALLATION <br />�INSTALL BACfM�ATER VAWE cu!side tte C��Jding) <br />❑ SIDE SEW[R CAP�OFF <br />❑ SIDE S[I�JFR RECONNGCTION <br />MULTIPLE DOMESTIi. WATER SERVICES REQUEST <br />L7 I Aid DECLINING A9ULTIPLE DO�dESTIC WATLR SERVICES FOR <br />I:tY PdULTI-FAt.11LY DEVELOPIv7ENT UNDER SINGLE OWNERSHIP <br />❑ I AI�1 OPTING TO INSTALL iv1ULTIPLE DOIdESTIC WATER <br />SERVIC[S POR �a7Y �olULT6FAMILV OEV[LOFi+�-NT �1NDCR <br />SINGLFOWNERSHIP FILLOUTl7EVERSESIDEOFTHISl=ORId. <br />G NENJ WATER SERV:CE INSTALLATIOIJ <br />❑ COP.:PLE7F. SERVIG� ❑ h"ETER GV, Y <br />SERVICE %.'��E?ER ;;Sc � <br />❑ SFR <br />❑ MULT6fAf:LY �+ O� LIIVITS <br />❑ COi�11v1ERGl�L <br />WATER SERVICE iYPE I SIZE� (ciicle desired sre) <br />❑ DOAIESTIC 3/4", 1". 2", <br />❑ IRRIGATION. 3l4", 1", 2��, <br />❑ FIRE. ��. Z.. 4�• ��� 8.. <br />❑ DO!.ii-S1'ICIPIRi- CC�11B0� 1'. 2'. <br />OSi{cR <br />OTfiFR <br />OTHER <br />OTHF� <br />AGP,E[h�EN I T�ie untlec�9ned app':ca�rt agiee; ro compry �r�:lr au pro nsmns ol !ne Everctt L.'unic,p�l Caae iRlc <br />l�f lYa(er ar,tl �ec. c, m such ofher rules an0 regu�afrons now exrslmg or �+hich may be es,'u60s�etl Go�n f�.me (o <br />r,r�e i0e ap�lcanl lurtn,rr agrces, as a conddron pmcedenf fo mcerving servr.-e fhnt Ihe uhi�fies di�asion sna,4 navc <br />'he ngM af any hmr, n�;;nout no9ce. !o shut o�l orlum on fhe walei suppty for repa.rs. cons!ruclion, antl <br />ncnpaymento/c�z�9esorlo�anyofherieasonaD.'eca amineawne�.orlamaulAonredGylheownerolfh;s <br />p;oJxrty lo peAortn flre work lor w0�ch aODl�calion ' matle, a.d�(�y omply i•, Sfa!e Conhaclors Law fU 27 <br />kCW and 19c 2COA WaC U�� <br />, -� _ � , ,-� P-,�� <br />9ent Siqnaturc <br />Gty o! L-verc:t Olfnal Use Onry <br />FF_E � � � O � <br />J / <br />PGf2i:�11T� Y <br />U i � �2� 03�' <br />�n„�.,s�e ,a,uzo, , <br />