ENG2023-0148_Utility_Application_3.22.2023_8.56.13_AM_3435633SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name Select Homes, Inc.
Phone Number (425) 742-6044
Email kayla.clark@outlook.com
Address 8304 212th St SW
City Edmonds
State WA
Zip 98026
Property • •
Project Name 22214 98th Ave. W. 3 lot conservation short plat
Associated Permit Number PLN2022-0088
Address 22214 98th Ave. W
City Edmonds
State WA
Zip 98020
Parcel No. 00450700300002
Does the property currently have sewer service? X Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
New 3 lot short plat
In what phase is the project?
❑ Design Review
® Preliminary Plat
❑ Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
PLN2022-0088
E 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: &�< A-- DATE: 3/22/23
APPLICANT PRINTED NAME: Kayla Nichols, Select Homes, Inc.
Form Updated 12/9/2021