REVIEWED BLD2022-0046+SEWER AVAIL+1.24.2022_10.41.01_AM+2636671RECEIVED
BLD2022-0046
Jan 24 2022
CITY OF EDMONpt of EDA C>+�
DEVELOPMENT SF�Y
DEPARTME
"VC. 1 S90
SECTION A
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
REVIEWED
RY
Applicant Information
Contact/Applicant Name Select Homes, Inc.
Phone Number 425.742.6044
Email kayla.clark@outook.com
Address 8304 212th St. SW
City Edmonds
State WA
Zip 98026
Property • •
Project Name 20323 81 st Ave W 2 lot Short Plat - lot 2 SFR
Associated Permit Number BLD2022-0046
Address
City Edmonds
State WA
Zip 98026
Parcel No.
Does the property currently have sewer service? (A Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
One 2 story 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
PLN2021-0007
® 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 A- DATE: 1.24.22
APPLICANT PRINTED N
Kayla Nichols, Select Homes, Inc.
Form Updated 12/9/2021