HomeMy WebLinkAbout_CITY OF ARLINGTON •
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: ❑ Water Only ❑ Sewer Only 0 Water and Sewer
Occupancy: 0 Single Family ❑ Duplex ❑ Multi-Family ❑ Commercial ❑ Industrial ❑ Institutional
Legal Property Address: 8917 172nd Place NE
Lot#: 17 Parcel ID Nos : Subdivision: Allen Tonwhomes
Owner Name: LGI Homes—Washington Office No.:
Email Address: scott.kauffman@terratahomes.com Cell No.: 9167303796
Mailing Address: 1450 Lake Robbins Dr Suite city: The Woodlands State: TX Zip:77380
Owners Agent: LGI Homes -Washington Office No.:
Email Address: scott.kauffman@terratahomes.com Cell No.: 9167303796
Mailing Address: 11250 Kirkland Way Suite 2 city: Kirkland State: WA Zip: 98033
GENERAL INFORMATION
Give a brief description of your proposal and/or request:
Single Family Construction
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 FIND
Water Meter Size Requested? 0 5/8" ❑ 1" ❑ 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.
Scott Kauffman Digitally signed by Scott Kauffman Scott Kauffman 5/6/2026
Date:2026.05.06 09:36:43-07'00'
Signature(owner/agent) Print Name Date
REV03.2022