ENG2023-0122_Utility_Application_3.3.2023_12.09.29_AM_3399425EC,tUI
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WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name Roger Cecil
Phone Number
206 484-3495
Email
rogerc@cecilnassoc.com
Address
PO Box 598
City
Bothell
State WA
zip 98020
InformationProperty Project Name Sandy Ridge 5 Short Plat
Associated Permit Number 121M-2021 _nn7.o PLN2022-0079
Address 21714 92nd Ave W
City Edmonds
State WA
zip 98020
Parcel No.
Does the property currently have water service? ?§ Yes (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
Short plat a 0.49 acre property into 2 single-family lots. Zoning is RS-8
In what phase is the project?
❑ Design Review ❑ Building Permit
0 Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: Pl4i-2n-21_nrrmo PLN2022-0079
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.
APPLICANT SIGNATURE: �D DATE: 2/28/23
APPLICANT PRINTED NAME: Kog_er J. Cecil
Form Updated 12/9/2021