SEWER AVAILABILITY CERTIFICATE ENG2023-0210RECEIVED
Apr 20 2023
CITY OF EDMONDS
s SEWER AVAILABILITY APPLICATION DEVELOPMENT SERVICES
DEPARTMENT
Complete and submit this form through . Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Sanitary Sewer Main.
SECTION A
.\1�1)licant Information
Contact/Applicant Name M(Ou-tt Mc1A,.J ?Aq S�r/krLLAC A4Aww-S1% M•11 Co +J
Phone Number
Email 4-C 4,-0 '8 10 C9 mow..' 1. c
Address S 3i ^• Ave S
City VAN/ State JoVA, Zip Q�,-L—
Project Name t(/� SAJ
Address S S 8 M.AS n► 1r" a T'
City UMW i"O S I
State GV'f Zip cam"
Parcel No. O O L'3+ Z l 7— 0 0 1 S d)O
Does the property currently have sewer service? Xes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building): /
2 3 Sso d- 50 M a.I.,a S74Cdra T. z s ra 2VWJ , 6 M&" 47 Ta" r
Study is reqLfired for new commercial building at 558 Main St.
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
�Kbuilding Permit A) j5*<_ C.i oy9J&1 tv ✓\
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
PL.O 20 z.3 - o C 03
Exemptions from Utility Availability Study: 1) Single-family residence; 2) Multi -family project of four
units or less; 3) Short plat subdivision (four single-family lots or less). Please check one of the following:
AA utility availability study IS NOT requested/required. The applicant certifies that this project
is exempt from needing a study as described above and is not requesting a full utility availability
study at this time. Please sign below and submit this form through vivx .MyBuildingPermit.com.
X A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through J'erniit.coni.
Study is required for new commercial building at 558 Main St. !
APPLICANT SIGNATURE: � DATE: `/�' — /77- 2,3
APPLICANT PRINTED NAME: s:'(G'eZ T/(/! ��•� ��. Y
Form Updated 3/28/2023
SECTION C
1. ll a. Sewer service will be provided by side sewer connection only to an existing
size sewer main that is 10 feet from the site.
OR
❑ b. Sewer service will require an improvement to the sewer system of:
8" CIPP
❑ (i). feet of sewer main to reach the site; and/or
❑ (2). The construction of a collection system on the site; and/or
❑ (3). Other (describe)
2. a. The sewer system is in conformance with a City approved sewer comprehensive plan.
OR
❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.)
3. l!� a. The proposed project is within the corporate limits of the City, or has been granted
Boundary Review board approval for extension of service outside the City, or is within the City approved
service area of a private water purveyor.
OR
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
Sewer Agency Certificatinn
Comments/Conditions:
Sewer service connection shall be made to existing 8" CIPP gravity sewer main
located in alley directly to south of 558 Main Street.
I hereby certify that the above information is true. This certification shall be valid for one year from the date of signature.
City of Edmonds - Engineering
Russell Lynch
(Agency Name)
(Signatory Printed Name)
Capital Projects Manager
E= 4/27/2023
(Title)
Si nature Date
Form Updated 3/28/2023