Martin - Water Availability Applicationof rDA,10
C. i st)o
SECTION A
RECEIVED
WATER AVAILABILITY APPLICATION AUG 12 2022
Complete and submit this form through www.MyBuildingPerrn it.com.
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Applicant Informat-1011
Contact/Applicant Name j
Phone Number
Email 1 A4 < 1
Address 9`
L1
City vW
State
zip
Property Informatioii
Project Name.. g,
1�
Associated Permit Number
Address iwe-
City
State
zip
Parcel No.
Does the property currently have water service?
JR Yes (City of Edmonds water) ❑ No
Proposed Dex-elopment
In what phase is the project?
Design Review
IN Preliminary Plat
er f units, number of
t A P tit c-
❑ Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable: P i..,M 2,02- '1 - 0 0 Z"-7
Applicabilih-
Applicant certifies that this project is a single-family residence, multi -family project of four units or
less with combo water/fire lines, 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.MyBuildingPerrnit.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.MyBuildingPerinit.com.
APPLICANT SIGNATURE: C'�t�a
DATE.
/ J
APPLICANT PRINTED NAME:L(-)a l f t �d
Form Updated 12/9/2021