HomeMy WebLinkAbout2025.03.18 Utility Service Connection Application I
UTILITY SERVICE CONNECTION APPLICATION
Community and Economic Development
City of Arlington• 18204 59th Avenue NE•Arlington,WA 98223 •Phone(360)403-3551
Submittal Requirements:
I. 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: ❑ Water Only 0 Sewer Only ❑ Water and Sewer
Occupancy: ❑ S:ingle Family ❑ Duplex ❑ Multi-Family ❑✓ Commercial
❑ Industrial ❑ Institutional
Legal Property Address: 6001 192nd St NE Arlington WA 98223
Lot#: Parcel ID Nos : 31051500401215 Subdivision:
Owner Name: 213RND LLC Office No.: (425)-870-8259
Email Address: Brent@globalmachineworks.com Cell No.: (360)-386-8563
Mailing Address: 19132 59th DR NE City: Arlington State: WA Zip: 98223
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:
Commericial building is being remodeled, they are adding another restroom.
We are planning to connect to the Existing Manhole/Maintenance Manhole onsite that is 26 Feet away from the building
WATER AND SEPTIC SYSTEM INFORMATION
Is there an existing Well on the property? [:]Yes Z No Is there an existing Septic System on-site? ❑Yes ❑✓No
Decommissioning of existing Well(s)and/or Septic System is required when connecting to city utilities
Is a Water Meter Required? ❑Yes ❑✓ No
Water Meter Size Requested? ❑5/8" ❑ 1" ❑15" ❑2" ❑3"
❑4„ ❑6„
1 hereby certify that the above i mation is correct and that the construction on,and the occupancy and the use of the above
descr" operty will be in ordance with the laws,rules and regulations of the State of Washington.
Zgna ure(owner agent) PrmtName Date
REV03.2022
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