HomeMy WebLinkAbout20260630_PJA26-0312_App •
UTILITY SERVICE CONNECTION APPLICATION
Community and Economic Development
City of Arlington• 18204 591h Avenue NE•Arlington,WA 98223 • Phone (360) 403-3551
Submittal Requirements:
1. Complete Application
2. 8-1/2" x 11" Site Plan/Sketch of the Proposal
3. Payment and Permit issuance is required prior to water meter installation
Type of Request: 0 Water Only ❑ Sewer Only ❑ Water and Sewer
Occupancy: ❑ Single Family ❑ Duplex ❑ Multi-Family 0 Commercial ❑ Industrial ❑ Institutional
Legal Property Address: 19700 67th AVE NE
Lot#: Parcel ID Nos : 31051500101500 Subdivision:
Owner Name: SNOHOMISH CO PW-Roads Div.1 Office No.: 425-388-7145
Email Address: James.Turner@snoco.org Cell No.: 425-583-8564
Mailing Address: 3000 Rockefeller AVE US 4 City: EVERETT State: WA Zip: 98201
Owners Agent: Eric Nordstrom Office No.: 425-262-2806
Email Address: eric.nordstrom@snoco.org Cell No.: 425-327-4179
Mailing Address: 3000 Rockefeller AVE US i city: Everett State: WA Zip: 98201
GENERAL INFORMATION
Give a brief description of your proposal and/or request:
Application for irrigation water meter installation for main permit number BLD-6487
(any utility bills should be directed to: Tasha Colson, 425-388-3193, SFM-Payables@snoco.org)
WATER AND SEPTIC SYSTEM INFORMATION
Is there an existing Well on the property? ❑Yes 0 No Is there an existing Septic System on-site? OYes E]No
Decommissioning of existing Well(s)and/or Septic System is required when connecting to city utilities
Is a Water Meter Required? ✓ Yes E]No
Water Meter Size Requested? ❑ 5/8" ❑ 1" 0 1.5" ❑ 2" ❑ 3" ❑4" ❑ 6"
l hereby certify that the above information is correct and that the construction on,and the occupancy and the use of the above
described property will be in accordance with the laws,rules and regulations of the State of Washington.
9�adeva,d�,om Ero 6/30/2026
Nordstrom, Eric oa�eEzoisos3o;z°3o=�onom,=n��=,�� �o,d=.,om E,�
o,oa
Signature(owner/agent) Print Name Date
REV03.2022