ENG2023-0139_Utility_Application_3.15.2023_4.32.28_PM_3423832l/0 of ELP1,1()4/
/Nc. 1 sa0
SECTION A
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
Applicant Information
Contact/Applicant Name Alexandra Immel Residential Design, LLC
Phone Number 206-501-3038
Email info alexandraimmeldesign.com
Address 3439 NW 62nd St.
city Seattle
state WA
zip 98107
Property• •
Project Name Haider Residence
Associated Permit Number BLD2022-1324
Address 915 Brookmere St.
city Edmonds
state WA
zip 98020
Parcel No. 00548900000302
Does the property currently have sewer service? X Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
Proposed 2-story addition to (E) single family residence, 1 building, 1 unit
In what phase is the project?
XI-1 Design Review
❑ Preliminary Plat
® Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
BLD2022-1324
® 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: 1,,, Pu h : DATE: 2.8.2023
APPLICANT PRINTED NAME: Jessica Kashian for AIRD
Form Updated 12/9/2021