ENG2023-0073_Utility_Application_2.6.2023_9.13.52_PM_3354720RECEIVED
Feb 07 2023
CITY OF EDMONDS
of EDtit DEVELOPMENT SERVICES
tin DEPARTMENT
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
�Nc. isao
SECTION A
Applicant
Contact/Applicant Name
Phone Number
Email
Address
City_ State ,a zip E //
Property hiforniation
Project Name ",,,,,, e�� & S ) c e,
Associated Permit Number '4—C' L•- C", ' S+'
Address
city f l,'1111)s State a Zip $�7
Parcel No. r_->G, 3.71 iv0 !pC% 7 CC)
Does the property currently have sewer service? pYes (City of Edmonds sewer) O No
Describe project (number of buildings, number of units, number of stories per building):
toll S. ••5/t Ak' Z yy S%��- St':„ems
1
�� <^s� r��-- IOC'`K` `✓., SJ�af Cct P"q—zl .
In what phase is the project? I
❑ Design Review �! Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
P 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.VftBuildingPermit.com01/ 11 Z
APPLICANT SIGNATURE: DATE: 5 ^� 2
APPLICANT PRINTED NAME:_
Form Updated 12/9/2021