ENG2023-0074_Utility_Application_2.6.2023_9.16.51_PM_3354729RECEIVED
Feb 07 2023
CITY OF EDMONDS
pF EPA10yJ DEVELOPMENTDEPARTMENT
RVICES
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
/Nc. I Sao
SECTION A
Applicant
Contact/Applicant Name
Phone Number Z b - `f09_
Email
Address 5 7—
city State
zip IrR2,
Propeity Information
Project Name G . n , �� S2 c,
. 6 -1ce—
Associated Permit Number i-'> G:
Address
City Lf d t ^ �S State A
� •) � Zip q $o e'- i/
Parcel No. Z)D 3 i t °I a c, 10 0 7 OCR
Does the property currently have water service? ❑ Yes (City of Edmonds water) p No
Describe project (number of buildings, number of units, number of stories per building):
In what phase is the project?
❑ Design Review 4 Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
,® 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.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.M uildin Permit.com.
"3 / - Z -2—
APPLICANT SIGNATURE: DATE:
APPLICANT PRINTED NAME: ti <: Z t� , J7,'�n.�
Form Updated 12/9/2021