ENG2023-0123_Utility_Application_3.3.2023_12.06.35_AM_3399421OF EDA104/
INC. 13a0
SECTION A
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
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
Property • •
Project Name Sandy Ridge 5 Short Plat
Associated Permit Number Pl P42921 GG7-9 PLN2022-0079
Address 21714 92nd Ave W
city Edmonds
state WA
Zip 98020
Parcel No.
Does the property currently have sewer service? 6 Yes (City of Edmonds sewer) ❑ 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
x❑ Preliminary Plat
❑ Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
of ni2n-21-nma PLN2022-0079
® 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: DATE. 2/28/23
APPLICANT PRINTED NAME: Koger J. Cecil
Form Updated 12/9/2021