WATER PERMIT APPLICATION

SITE AND PROJECT DATA

Check which is applicable:

Residential

Commercial

Check which is applicable:

Inside City Limits

Outside City Limits

Description of Work:

Parcel Number

Lot Number:

Plat/Development:

Property Size

No. of Bldgs. on Site:

Sewage disposal:

Septic

Sewer

Sewer Contractor License # (If outside City Limits the applicant must provide proof of approved septic or sewer service at the time of application)

Property Owner's Phone Number

Property Owner's Email Address

The applicant name and address shall be used for future utility bills.

Is the Applicant someone other than the property owner?

Yes

Applicant Phone Number

Applicant Email

Is there a separate contact for this project?

Yes

Project Contact Phone Number

Project Contact Email

All inspection results shall be emailed to:

Contractor Name:

Contractor Phone Number

Contractor Email

UBI #

Contractor Lic #

METER DATA

Lender/Issuer of Payment Bond:

Other:

Fire Sprinkler Required

Yes

Check which is applicable:

Domestic

Irrigation

Meter Size

Number of Dwelling Units:

Number of Commercial Units:

Lender/Issuer Phone Number

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I hereby apply for the use of water in accordance with the rules and regulations of the City now existing or hereafter made or amended and I hereby agree to take water from the City for the premises hereon, charges for the same to be paid at the office of the City in accordance with the rules and regulations of said Water Department; and I hereby covenant and agree that I will protect and save harmless the said City from all claims for damages occasioned by the bursting of any pipes for the supplying of water at my cost and charge according to said regulations, for which I have been duly notified. IMPORTANT! The City installs meters that are sized to provide water for domestic purposes and does not consider fire suppression sprinkler systems in determining the size of the service line or meter. If you wish to install a fire suppression system/sprinkler system, it is your responsibility to do a study to determine what size service line and meter will be required to serve that fire system. The City makes no statement or warranty of any kind that sufficient volume of water is available to service a fire suppression/sprinkler system. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Any changes will be reported to the jurisdiction in which the permit is valid immediately. By leaving the contractor information section blank, I hereby certify further that contractors (general or subcontractors) will not be hired to perform any work in association with this permit. I also certify that if I do choose to hire a contractor (general or subcontractor) I will only hire those contractors that are licensed by the State of Washington.

Signer:

Owner

Agent

Contractor