ENG2023-0153_Utility_Application_3.22.2023_2.58.58_PM_3437353SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name Lee A. Michaelis
Phone Number 425 830-1046
Email lee.michaelis@pugetsoundplanning.com
Address 6100 219th St SW Suite 480
city Mountlake Terrace
I stateWA
zip98043
Property information
Project Name
Chung SFR
Associated Permit Number
BLD2022-1176
Address
727 Bell St
city
Edmonds
state WA
zip 98020
Parcel No.
00434208603300
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) N No
Describe project (number of buildings, number of units, number of stories per building):
Construction of one, two-story detached 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
BLD2022-1176
® 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 SIGNA
APPLICANT PRINTED
Lee A. Michaelis
DATE: March 22, 2023
Form Updated 12/9/2021