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� <br />�� <br />WA�R / SEWER UiiLITY A�LICATION <br />CITY OF EVER[TT PERti11T SERVICFS <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.evereltwa.guv/permits <br />UTfLITY APPLICATION INFORMATION <br />SEWER (check all that apply) WATER (check all that apply) <br />❑ SIDE SEWER REPAIR � �-p ❑ NEW WATER SERVIGE INSTALIATION <br />� SIDE SEWER ALTERATION �`� t"I N c sl��� O COMPLETE SERVICE ❑ METEf2 ONLY <br />❑ NEW SIDE SEWER INSTALIATION SERVICE / MEfER USE� <br />❑ INSTAIL BAGKWATER VALVE (oulside the building) ❑ SFR <br />O SIDfl SEWER CAP-OFF ❑ h1ULT6FAMILY - k OF UNITS: <br />❑ SIDE SEWER RECONNECTION C; COMMERCIAL <br />MULTIPLE DOMESTIC WATER SERVII:ES REQUEST WATER SERVICE il'PE / SIZE (cvcie des�red s�ze) <br />❑ I A�ut DECLINING MULTIPLE DOMESTIC WATER SERVICES fOR ❑ �O�dESTIC� 3/4", 1", 2", OTHER� <br />MY MULTbFAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION� 3/4", 1", 2", OTHER <br />❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE�. t", 2". 4". 6", 8", OTHER. <br />S[RVICES FOR MY P+tULTI-FAMILY DEVELOPMENT UNUER ❑ DOt�1ESTIClFIRE COMBO: 1". 2", OTHER� <br />SINGLE OWNERSHIP. fILL OUT REVERSE SIDE OFTHIS FORM. <br />AGREE�dENT: Tne untlers�gnetl apphcanl a9mes fo comply wdh alf provisions o/ fhe Eveietl h1vnmpal Cotle tRie <br />iJ Wa(er and Sewer or sucb olher rules and rrgu�ahons now exisi:ng or which mey be eslabAshed Imm fime fo <br />hme. The applicant lurthe/ a9rees, as a contlilion pretetlen! lo Bcer.ag servme fhaf fhe uhlities d�nsion shall �a�e <br />fhe f.ghl al any fime, �cRhoul rtohce, fo shut of/ or lum on the u'afer supp�Y' forrepairs, consWcbon. antl <br />nor,paymenlolcharg^sorloranyofhermasonablecause Iamtheor:ner,oNamaulhonzedbylneov:nerolthis <br />p�operty lo pcAomi fhe nork !or wh¢h app�icelio�r is made, and I tompry wAb fhe Sta1e Cenlracfors Law IH 27 <br />'7CW antl e9GTp0A INAC � <br />Agem `gnaWre Dale <br />Gty of Everett Ol6cw� Use Only <br />FEE <br />� 30, o0 <br />PERMIl' # <br />U 1663-0/8 <br />(Revised f0/12/2075) <br />