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o NO o NEW WATER SERVICE INSTALLATION o NEW COMPLETE SERVICE o METER ONLY o DOMESTIC: o IRRIGATION: o FIRE: PERMIT # U Owner/Authorized Agent Signature Date (Revised 4/21/2022) o OWNER o CONTRACTOR o OTHER (Please Specify) CONTRACTOR PHONE: o I AM OPTING TO INSTALL MULTIPLE DOMESTIC WATER SINGLE OWNERSHIP. FILL OUT REVERSE SIDE OF THIS FORM. CONTRACTOR LIC. #(REQUIRED): o3/4" o1" o2" oOther : o1" o2" oOther : o1" o2" o4" o6" o8" oOther : WATER / SEWER UTILITY APPLICATION PROJECT ADDRESS: BUILDING TYPE: oSFR oTOWNHOUSE oDUPLEX oADU oMULTI-FAMILY-# OF UNITS:_____ oCOMMERCIAL oACCESSORY CONTACT INFORMATION: [PHONE REDACTED] I [EMAIL REDACTED] I everettwa.gov/permits PROJECT SITE INFORMATION CITY OF EVERETT PERMIT SERVICES SUBMITTAL INSTRUCTIONS: Drop off hard copy paper application & plans to 3200 Cedar Street 2nd Floor Intake Drop Box. IF APPLICABLE: o OUTSIDE CITY LIMITS o BUILDING o LOT MULTIPLE DOMESTIC WATER SERVICES REQUEST o I AM DECLINING MULTIPLE DOMESTIC WATER SERVICES FOR SERVICES FOR MY MULTI-FAMILY DEVELOPMENT UNDER o YES, FROM TO MY MULTI-FAMILY DEVELOPMENT UNDER SINGLE OWNERSHIP. o3/4" o1" o2" oOther : o WATER LINE BEHIND METER (repair or alteration) o SIDE SEWER ALTERATION o NEW SIDE SEWER INSTALLATION o INSTALL BACKWATER VALVE (outside the building) o SIDE SEWER CAP-OFF o SIDE SEWER RECONNECTION CITY STATE ZIP CITY STATE ZIP UTILITY APPLICATION INFORMATION SEWER (check all that apply) WATER (check all that apply) o SIDE SEWER REPAIR CONTRACTOR NAME: OWNER MAILING ADDRESS: STREET CHANGE OF USE? CONTACT INFORMATION 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. OWNER EMAIL: TENANT BUSINESS NAME (If Commercial): OWNER NAME: PRIMARY CONTACT: OWNER PHONE: CONTRACTOR EMAIL: CONTACT NAME: CONTRACTOR ADDRESS: STREET CITY OF EVERETT BUSINESS LIC. #(REQUIRED): CONTACT EMAIL: CONTACT PHONE: o DOMESTIC/FIRE COMBO: Specify water service type & size below: oRPBA (dom.) oDCVA (dom.) oDCVA (irr.) oDCDA (fire) o BACKFLOW PREVENTION (Outside) - Specify device type below: Specify installation type below: ---PAGE BREAK--- o 3/4" Domestic Water Service X o 1" Domestic Water Service X o 2" Domestic Water Service X Date Applicant Signature Date City of Everett Office Use Only Approved By: Utilities Department Authorized Signature (Required) 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