ENG2023-0131_Utility_Application_3.6.2023_3.15.07_PM_3404480RECEIVED
Mar 06 2023
O1 EC),tlUI/ CITY OF EDMONDS
� DEVELOPMENT SERVICES
' WATER AVAILABILITY APPLICATION DEPARTMENT
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name Joseph Rowett for Landsverk Quality Homes, Inc.
Phone Number 425-760-9218
Email joseph@lqh-inc.com
Address 24113 56th Ave W
city Mountlake Terrace
State WA
zip 98043
Property Information
Project Name Iron Vista Lot A
Associated Permit Number BLD2022-0926
Address 19xxx 94th Ave W 19128 94TH AVE W
City Edmonds
State WA
zip 98020
Parcel No. 00434600006102
Does the property currently have water service? ❑ Yes (City of Edmonds water) X No
Describe project (number of buildings, number of units, number of stories per building):
1 single family residence. 1 story above grade with 2 basements below
In what phase is the project?
❑ Design Review ® Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: BLD2022-0926 & BLD2022-1035
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.MyBuildingPermit.com.
Joseph Rowett 8-29-22
APPLICANT SIGNATURE: bPso.�- DATE:
APPLICANT PRINTED NAME: Joseph Rowett
Form Updated 12/9/2021