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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 /> Date <br /> szci 5213 Clenwoodt RNte ere c<62,b3 bir367 oOD2zr <br /> PROJECT ADDRESS (Please attach site plan with proposed water services shown) TAX PARCEL NO. <br /> 10Alk. -roc V\ . r\ 1 V Opvvve vtz7 , <br /> Property Owner <br /> 1(/ X -2_11 <br /> Mail Address <br /> 1v 11 C,►�,�e,l�-- WA- °10t2_ <br /> City State Zip <br /> TM p (4,-)es--) ak-L--694-1 <br /> Email Address Phone Number <br /> Number of Services Requested: <br /> 3�4 X_ X_ 2 „ <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 connection(s) 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 the <br /> charge for water consumed shall be computed separately for each metered service; provided that the premises shall remain <br /> liable fora lien for water charges as provided in Section 14.16.850. (Ord. 1237-86 § 43, 1986) <br /> I hereby consent to the terms of EMC 14.16.430 listed above: <br /> V1,1 (B - 1 0 , <br /> Appli ant Signature Date <br /> Office Use Only <br /> Approved by: <br /> Cf3 ( � <br /> Aut}Sorized Signature D e <br /> REVISED 11/19/2014 <br />