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WATER / SEWER UTILITY APPLICATION <br />.�. CITY OF EVFRFTT P[RM11 SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />(p) q25-257-8810 � FAX 425-257-8857 ;(F) everetteps@everethva.gov � �vww evere?twa govlpermils <br />PROJECT SITE INFORMATION <br />tOJECT ADDRESS: � bl, p �-Y- C�J <br />APPLICABLE: ❑ OUTSID[ CITY LIAIITS ❑ �UILDING AR[A SF ❑ LOT # <br />LDING TYPE: ❑SFR-DETACH[� ❑SFR•ATTACHED ❑DULEX OIdULTI�FA�dILY-ti OF UNITS ❑COYMERGAL ❑iN�USTRiAL <br />OF USE? ❑ NO ❑ YES, FROtut <br />TO <br />UTILITY APPLICATION INFORMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />❑ SIDE SFWcR R[PAIR ❑ NEW WATER SERVICE INSTALLATION <br />❑ SIpE SEWER ALTER�TION ❑ COMPLETE SERVICF ❑ METER ONLY <br />❑ NEW SIDE SEWER INSTALIATION SERVICE / METER USE <br />� INSTALL BnCKWATER VAWE (oWs�ae the Li,�id�ng) ❑ SFR <br />❑ SIDE SEWER C�P-OPF ❑ �dULTI-FAMILY- # OF UNITS _._____ ___ <br />❑ SIDE SEWER R[CONNECTION ❑ COMMERCIAL • <br />MULTIPLE DOMESTIC WATER SERVICES REQUEST WnTER SERVICE TYPE / SIZE (circle tles�red s.e) <br />❑ I nM DECLINING �+1ULTIPLE DOM[STIC \NATER SERVICES FOR ❑ DOtv1ESTIC 3�4", 7", 2�. OTHFF __ <br />MY h1ULTl•FAMILY DEVELOP�deNT U�JDER SINGL[ OWNERSHIP ❑ �RRIGATION 3/a", i", 2", OTHER <br />❑ I A�t OPTING TO INSTALL MULTIPLE DOMESTIC WATLR ❑ RRF i'� 7'�. a", 6", B", OTHER <br />SERVIC[S FOR h1Y MULTI-FAMILY DFVELOPMENT UNDER ❑ DO\tE5 � IC�RRE COiv1B0 �. 2". OTHER <br />SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. <br />AGRcPh!LNT The untlersgned appl�cvm agrees to compty r.;th an pmvuions ol fne Everetl I.!unrc�pal CoOe 7R!e <br />t: 1;�ale� antl Seweror such olner ivles an0 m9Walions now e.a(mg o� which may De esto�hshetl Irom hme lo <br />;:ma 7he appLcanl futlher agrnes, as a contld�o� pmce�ml fo �ecervinq semre Inal Me uldAies C�vis�on shali havc <br />Ine nghl al any hme. �:i;houl no6[e, fo shul or/ or fum on the ��ater supp�Y Por mparrs. tonsVucLoq and <br />r.onpaymml ol charges orlor any ofhcr renionaDfe [ause I am I�e o����ei, or 1 am aulhonzed �y fhe owner ol fhis <br />pmpe�ly m peAorm :l+e «c�k lo �c� npP��Wl�on i5 matle, a�tl l comply �r;th Lhe $fafe Con;raClor, Law 18 27 <br />RCth�and2962C04 NA(: � � � � �j�� �('� <br />� 5 � <br />Oate <br />eny or rvererr wna�u use u��ry <br />F[[ <br />��,0 ,° � <br />PERMIT # <br />U � ., , p�� <br />pZev�sed 10'12/201 ,1 <br />