ENP2022-0015 Sewer Availability Certificatel LU,Vv
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name Lauren Golembiewski- Glacier Environmental Services, Inc.
Phone Number 425-355-2826
Email LMiles@glacierenviro.com
Address PO Box 1097
City Mukilteo
State WA
Zip 98275
Property Information
Project Name Glacier Environmental Services- New Construction
Associated Permit Number Pj,N2022-0028
Address 7509 212th St SW
City Edmonds
State WA
Zip 98o87
Parcel No. 005669004Oo600
Does the property currently have sewer service? ml Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
Proposed development includes 2 new buildings: a 4600SF 2 story office and 320oSF warehouse
In what phase is the project? RECEIVED
V Design Review ❑ Building Permit APR 12 2022
❑ Preliminary Plat
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
❑ Applicant certifies that this project is a single-family residence, multi -family project of four units or
less, or short plat subdivision (four single-family lots or less), in which case completion of a full utility
availability study shall not be required. Please sign below and submit this form through
www.MyBuildingPermit.com.
VFor all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: Z_,5U� DATE: 4/12/2022
APPLICANT PRINTED NAME: Lauren Golembiewski
Form Updated 12/9/2021
SECTION C
1. a. Sewer service will be provided by side sewer connection only to an existing
size sewer main that is 35 feet from the site.
OR
❑ b. Sewer service will require an improvement to the sewer system of:
8" Concrete
❑ (i). feet of sewer main to reach the site; and/or
❑ (2). The construction of a collection system on the site; and/or
❑ (3). Other (describe)
2. iZ a. The sewer system is in conformance with a City approved sewer comprehensive plan.
OR
❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.)
3. V a. The proposed project is within the corporate limits of the City, or has been granted
Boundary Review board approval for extension of service outside the City, or is within the City approved
service area of a private water purveyor.
OR
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
Sewer Agency Certification
Comments/ Conditions:
Existing City of Lynnwood sewer main located along 212th St SW, approximately
12 feet from the site. Side sewer connection must be made to City of Edmonds
sewer main.
I hereby certify that the above information is true. This certification shall be valid for one year from the date of signature.
City of Edmonds - Engineering
Russell Lynch
(Agency Name)
(Signatory Printed Name)
Associate Engineer
4/21/2022
(Title)
(Si nature Date)
Form Updated 09/02/2021