Laserfiche WebLink
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 /> 1� r2 ism <br /> Date 5 / <br /> 71/._te4 f r.. <br /> PROJECT ADDRESS (Please atta site pla with proposed water se ices shown) TAX PARCEL NO. <br /> Property Owner <br /> -3C ft "• S'r - Jf& A- <br /> Mail Address <br /> ge2,0 <br /> City State Zip <br /> Firn L, <br /> *Oi— 5V/ ‘44 / <br /> Email Address Phone Number <br /> Number of Services Requested: <br /> X-3/4 " <br /> X- 1 " X-2" <br /> EMC 14.16.430 Single and multiple meteredservices—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 for a 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 /> 4:5( if- <br /> Applic n Signature Date <br /> Office Use Only <br /> Approved by: L,/ <br /> fo ! -- <br /> 5AuthatIr ' /2 - '/-(5--- <br /> Authorized <br /> orized Signature Date <br /> REVISED 11/19/2014 <br />