HomeMy WebLinkAbout20251107_PJA25-0056_App Utility Service P ermit A Ipplication
*denotes required fields
P roject Information
*Project Name: lArlington Boys & G Hs C
*D escription of Project:
C cntact Information
Owmr Information
*Owner Name: Boys & G Hs Club
*Office No.: 425-315-7082
*Email Address: mvolmer@becsc.org
*C dl No.: NA
*Mailing Address: 118513 59th Ave NE,
*C ty: Arlington
*State: WA
*Zip: 98223
Owmr A gent Information
•w wr Agent N am e: 12812 architecture
Office No.: 425-252-2153
Email Address: lydia@ 8812architecture
Cd1No.: INA
Mailing Address: 12812 Colby Ave
C ty: EVERETT
State: 1washington
Zip: 198201
Occupancy?
0Single Family includeing D etached Accessory D w(ling U nits
OD uplex
QMulti-Family
OC anmercial
QIndustrial
QInstitutional
Utility to be connected?
*Water O my
*Sewer Only
*Water and Sewer
Water and Septic System Information - Decommissioning of existing We and/or Septic System is
required when connecting to city utilities
Is there an existing Well on the property
QYes
*No
Is there an existing Septic System on-site?
QYes
ONo
Is a Water Meter Required?
OYes
*No
Water Meter Size Requested?
O 5/8„
Or
O 1.5„
O 2"
O 3"
O 4"
O 6"
A cknowledgement
I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the
above described property wfl be in accordance w1h the laws, rules and regulations of the State of Washington.
*Print Name: ILydia H ansen *Date: 2025-11-07
P ermit fee due at time of permit submittal. An invoice with link for payment will be sent to
the applicant email address once permit application is reviewed for completeness