Sewer Availability ApplicationRECEIVED
U1�?'. SEWER AVAILABILITY APPLICATION MAR 11 2022
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Complete and submit this form through www.MyBuildin Permit.cO1T1Q OF EDMO
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SERVICES DEPARTMENT
ZNc. 1890
SECTION A
Applicant Information
Contact/Applicant Name Select Homes, Inc.
Phone Number 425.742.6044
Email kayla.clark@outlook.com
Address 8304 212th St. SW
City Edmonds
State WA
Zip 98026
Property• •
Project Name 8929 220th St SW 2 lot Short Plat
Associated Permit Number PLN2021- 0038
Address 8929 220th St SW
City Edmonds
State WA Zip 98026
Parcel No. 00380300101000
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) ❑ No Olympic View Water and Sewer
Describe project (number of buildings, number of units, number of stories per building):
One single family residence
In what phase is the project?
❑ Design Review
Preliminary Plat
❑ Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
PLN2021-0038
® 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.
❑ For 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� /- DATE: 3.11.22
APPLICANT PRINTED NAME: Kayla Nichols, Select Homes, Inc.
Form Updated 12/9/2021