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MULTIPLE QUMEST(C WATER SERVICES REQUEST FC�RM <br /> NUMBER OF SERVlCES REQUESTED <br /> Select Meter Size List MeterlService Quantity <br /> ❑ 314"Domestic Water Service X <br /> �I 1" Domestic Water Service X 1 <br /> ❑ 2" Domestic Water Service X <br /> EMC 14.16.430 Single and multiple metered services -Regulations and Charges: <br /> On�y one me:ere� serJice cflnnEctior shall ncrmally be irsta!led to a pr�mises �nder�ingle o;r-nership. !f, ro��r�ever, <br /> a c�nsumer shall request that mare than one meiered service be c�nnected to a pramises under single ownership <br /> and the superintendent sha{I agree that the particular individuai circumstances warrant such additional <br /> connection(s}, the party requesting same shall make application and payment in the regular manner and such <br /> additional connection(s) shall be considered to be solelyfor the benefit and convenience of the applicant. The <br /> premises sha11 thereafter be charged for water service t�raugh each service connection independently as though <br /> senrice were being provided to two or more premises, and the minimum charge and the charge for watar consumed <br /> shall be computed separately for each metered service; provided that the premises shall remain Iiable far a lien far <br /> water charges as provided in Section 14.16.850. (Ord. 1237-86 §43, 1986) <br /> /herebv conseni to the ferms of EMC 14.1fi.430 lisied above: <br /> 3-4-16 <br /> Applicant Signature Date <br /> City of Everett Office Use Only <br /> Approved By: <br /> Utilities Department Authorized Signature(Requiredj Date <br /> �/�� <br /> �r.�,,�� <br />