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w�� v�� i�� i��'on� • CITY OF EVERETT PERMIT SERVICES 3200 CEDAR STREET, EVERETT, WA 98201 (P) 425-257-8810 � FAX 425-257-8857 � (E) everetteps@everettwa.gov � www.everettwa.gov/permits PROJEGT S17'E INFORMATION PROJECT ADDRESS: 1 2 /� �Y S . IF APPLICABLE; ❑OUTSIDE CITY LIMITS ❑ BUILDING AREA SF ❑ LOT# BUILDING TYPE; ❑SFR-DETACHED ❑SFR-ATTACHED ❑DULEX ❑MULTI-FAMILY�#OF UNITS: ❑COMMERCIAL ❑INDUSTRIAL CHANGE OF USE? N� ❑YES, FROM TO UTILITY APPLICATIOIV INFORIVIATION SEWER (check all that apply) WATER(check all that apply) ❑ SIDE SEWER REPAIR ❑ NEW WATER SERVICE INSTALLATION ❑ SIDE SEWER ALTERATION ❑ COMPLETE SERVICE ❑ METER ONLY ❑ NEW SIDE SEWER INSTALLATION SERVICE/METER USE: �INSTALL BACKVVATER VALVE(outside the building) ❑SFR ❑ SIDE SEWER CAP-OFF ❑ MULTI-FAMILY-#OF UNITS: ❑ SIDE SEWER RECONNECTION ❑ COMMERCIAL MULTIPLE DOMESTIC WATER SERVICES REQUEST WATER SERVICE TYPE/SIZE: (circle desired size) ❑ I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR ❑ DOMESTIC: 3/4", 1", 2", OTHER: MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. ❑ IRRIGATION: 3/4", 1", 2", OTHER: ❑ I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER ❑ FIRE: 1", 2", 4", 6", 8", OTHER: SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER ❑ DOMESTIC/FIRE COMBO: 1", 2", OTHER: SINGLE OWNERSHIP. F/LL OUT REVERSE SIDE OF THIS FORM. CONTACT INFORMATION OWNER NAME: � TENANT NAME(If Commercial): OWNER MAILING ADDRESS: sTReET CI7Y STATE ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: CONTRACTOR ADDRESS: sTREer � • CITY STATE � • ZIP CONTRACTOR PHONE: � CO TRACTOR EMAIL: • � CONTRACTOR LIC.#(REQUIRED): CITY OF EVERETT BUSIN LIC.#(REQUIRED : ._.,_. _. ._._., � . _.�_ _. ) PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME; , CONTACT PHONE: � L� 5�'b Z �I,�A Y��j ��`� �/�"�� CONTACT EfVIAIL: � � c � � � vvv AGREEMENT. The undersrgned applicanf agrees to comply wifh all provisrons of the Everett Municipal ode Title Cify of Ever f Official Use On/y 14 Water and Sewer or such other rules and regulations now exisfing or which may be established from time to FEE time. The applicanf fu�ther agrees, a c�' n precedent to receiving service that the ufilifies division shall have � O fhe�ight af any � e,w' t notic ,to shut off o turn on the water supply for repairs,consf�uction, and , 3� / nonpayment f ch r s or o�an otherreasona le cause.I am the owner,orl am authoriz.ed by the owner of this property to p or he wo hich applicafio is made,and I comply with the State Contractors Law 98.27 PERMIT# RCW and 29 200 Wf1C � �� f �� i i s�r wner/Authoriz gent Sig ature Date (Revised 90/12/2015)