ENG2023-0152_Utility_Application_3.22.2023_3.07.23_PM_3437380LL)t�U
WATER AVAILABILITY APPLICATION
Complete and submit this form through vww.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 state WA
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 water service? ❑ Yes (City of Edmonds water) M 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
M Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable: BLD2022-1176
SECTION B
M 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.WBuildingPermit.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 N.
:Lee A. Michaelis
DATE:March 22, 2023
Form Updated 12/9/2021