HomeMy WebLinkAboutWater-Utility Service Application03.202 (003) •
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 0 Industrial ❑ Institutional
Legal Property Address: 16512 51 ST AVE NE ARLINGTON WA 98223
Lot#: Parcel ID Nos : 31052800101700 Subdivision:
Owner Name: RG NORTHSOUND LOGISTICS LLC Office No.: 206-303-8792
Email Address: jkirk@rockefellergroup.com Cell No.: 206-640-6075
Mailing Address: 400 University St, Suite 300 city: Seattle State: WA zip: 98101
Owners Agent: Office No.:
Email Address: Cell No.:
Mailing Address: City: State: Zip:
GENERAL INFORMATION
Give a brief description of your proposal and/or request:
2" Water service meter for the building.
1" water service meter for irrigation.
WATER AND SEPTIC SYSTEM INFORMATION
Is there an existing Well on the property? ❑Yes ✓❑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" 0 1" ❑ 1.5" El 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.
y//"Uu- James P. Harlow 05.14.26
Sig ature(owner/agent) Print Name Date
REV03.2022