HomeMy WebLinkAboutCivic Plus Form Utility Service Permit Application
*denotes required fields
Project Information
*Project Name: Fred Retiguin-Marquina
*Description of Project:
Side sewer repair
Project Address: 1305 Maple Street
Contact Information
Owner Information
*Owner Name: IFred Retiguin-Marquina
*Office No.: 1305
*Email Address: fredmarquina0l@gmail
*Cell No.: 16193227168
*Mailing Address: 1305 E Maple Street
*City: lArlington
*State: Wa
*Zip: 98223
Owner Agent Information
Owner Agent Name: Mr. Rooter
Office No.:
Email Address: ken.carnahan@callmrro
Cell No.: 12063831768
Mailing Address: IPO Box 789
City: Gladstone
State: JOR
Zip: 197027
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
ONo
Is a Water Meter Required?
OYes
*No
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: IKen Carnahan *Date: 2026-04-21
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