HomeMy WebLinkAboutCivic Plus Form Utility Service Permit Application
*denotes required fields
Project Information
*Project Name: Kestrel
*Description of Project:
Install exterior clean out and hydro jet.
Crew is on site as customer is out of service
Project Address: 17707 Kestrel Ct
Contact Information
Owner Information
*Owner Name: Spencer Chynoweth
*Office No.: 206-931-7728
*Email Address: office@nwsewer.com
*Cell No.: 206-931-7728
*Mailing Address: IPO Box 55573
*City: IShoreline
*State: WA
*Zip: 98155
Owner Agent Information
Owner Agent Name:
Office No.:
Email Address:
Cell No.:
Mailing Address:
City:
State:
Zip:
Occupancy?
*Single Family includeing Detached Accessory Dwelling Units
ODuplex
O Multi-Family
OCommercial
O Industrial
OInstitutional
Utility to be connected?
OWater Only
*Sewer Only
OWater and Sewer
Water and Septic System Information - Decommissioning of existing Well(s) and/or Septic System is
required when connecting to city utilities
Is there an existing Well on the property?
OYes
*No
Is there an existing Septic System on-site?
OYes
*No
Is a Water Meter Required?
OYes
ONo
Water Meter Size Requested?
O 5/8"
011,
O 1.5"
O 2"
O 3„
O 4„
O 6„
Acknowledgement
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 will be in accordance with the laws, rules and regulations of the State of Washington.
*Print Name: Ijill Chynoweth *Date: 2026-06-26
Permit 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