Fillable 2054 Water/ Sewer Utility Permit Application (City of Everett)

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2054 Water/ Sewer Utility Permit Application (City of Everett)

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The 2054 Water/ Sewer Utility Permit Application (City of Everett) form is 2 pages long and contains:

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  • 57 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Everett

BROWSE CITY OF EVERETT (WA) FORMS

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o NO
o COMPLETE SERVICE o METER ONLY
o DOMESTIC:
o IRRIGATION:
o FIRE:
o BACKFLOW PREVENTION (Outside):
PERMIT #
U
Owner/Authorized Agent Signature Date
(Revised 10/12/2018)
City of Everett Official Use Only
AGREEMENT: The undersigned applicant agrees to comply with all provisions of the Everett Municipal Code Title 14 Water and Sewer or such other rules and regulations now
existing or which may be established from time to time. The applicant further agrees, as a condition precedent to receiving service that the utilities division shall have the right at
any time, without notice, to shut off or turn on the water supply for repairs, construction, and nonpayment of charges or for any other reasonable cause. I am the owner, or I am
authorized by the owner of this property to perform the work for which application is made, and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
o DOMESTIC/FIRE COMBO:
OWNER EMAIL:
TENANT BUSINESS NAME (If Commercial):
PRIMARY CONTACT:
OWNER PHONE:
CONTRACTOR EMAIL:
CONTACT NAME:
CONTRACTOR ADDRESS:
STREET
CITY OF EVERETT BUSINESS LIC. #(REQUIRED):
CONTACT EMAIL:
CITY STATE ZIP
CITY STATE ZIP
o MULTI-FAMILY - # OF UNITS:________________________
o COMMERCIAL
UTILITY APPLICATION INFORMATION
WATER (check all that apply)
CONTRACTOR NAME:
OWNER MAILING ADDRESS:
STREET
CITY STATE ZIP
CHANGE OF USE?
CONTACT PHONE:
CONTACT INFORMATION
o SFR
SERVICE / METER USE:
o YES, FROM _______________________________ TO ______________________________________
WATER / SEWER UTILITY APPLICATION
PROJECT ADDRESS:
BUILDING TYPE:
oSFR oTOWNHOUSE oDUPLEX oADU oMULTI-FAMILY-# OF UNITS:_____ oCOMMERCIAL oACCESSORY STRUCTURE
(P) 425-257-8810 | FAX 425-257-8857 | (E) everetteps@everettwa.gov | www.everettwa.gov/permits
PROJECT SITE INFORMATION
CITY OF EVERETT PERMIT SERVICES
3200 CEDAR STREET, EVERETT, WA 98201
IF APPLICABLE: o OUTSIDE CITY LIMITS o BUILDING AREA____________________SF o LOT #__________________
o OWNER o CONTRACTOR o OTHER (Please Specify) ___________________________________________
CONTRACTOR PHONE:
o NEW WATER SERVICE INSTALLATION
WATER SERVICE TYPE / SIZE: (provide calcs to support size choice)
CONTRACTOR LIC. #(REQUIRED):
o3/4" o1" o2" oOther :
o3/4" o1" o2" oOther :
o1" o2" oOther :
o1" o2" o4" o6" o8" oOther :
oRPBA oDCDA oDCVA
ELECTRICAL PERMIT APPLICATION
(P) 425-257-8810 | FAX 425-257-8857 | (E) everetteps@everettwa.gov | www.everettwa.gov/permits
CITY OF EVERETT PERMIT SERVICES
3200 CEDAR STREET, EVERETT, WA 98201
WATER / SEWER UTILITY APPLICATION
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o 3/4" Domestic Water Service
X
o 1" Domestic Water Service
X
o 2" Domestic Water Service
X
Date
Select Meter Size
List Meter/Service Quantity
Only one metered service connection shall normally be installed to a premises under single ownership. If, however,
a consumer shall request that more than one metered service be connected to a premises under single ownership
and the superintendent shall agree that the particular individual circumstances warrant such additional
connection(s), the party requesting same shall make application and payment in the regular manner and such
additional connection(s) shall be considered to be solely for the benefit and convenience of the applicant. The
premises shall thereafter be charged for water service through each service connection independently as though
service were being provided to two or more premises, and the minimum charge and the charge for water consumed
shall be computed separately for each metered service; provided that the premises shall remain liable for a lien for
water charges as provided in Section 14.16.850. (Ord. 1237-86 § 43, 1986)
I hereby consent to the terms of EMC 14.16.430 listed above:
EMC 14.16.430 Single and multiple metered services -Regulations and Charges:
MULTIPLE DOMESTIC WATER SERVICES REQUEST FORM
NUMBER OF SERVICES REQUESTED
Applicant Signature
Date
City of Everett Office Use Only
Approved By:
Utilities Department Authorized Signature (Required)
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2054 Water Sewer Utility Permit Application (City of Everett)

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Completed 13 February 2021

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