ENG2023-0134_Utility_Application_3.9.2023_12.13.36_AM_3410433RECEIVED
MAR 09 2023
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WATER AVAILABILITY APPLICATION CITY OF EDMONDS
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Complete and submit this form through www.MyBulldingPermit.CC)I17.VICES DEPARTMENT
SECTION A
Applicant Information
Contact/Applicant Name Motionspace Architecture + Design (contact: Jack Bader)
Phone Number 206-495-5847
Email jack@motion-space.com
Address 3104 Western Ave #107
city Seattle
State WA
zip 98121
Property Information
Project Name Koh Residence
Associated Permit Number PRE2022-0010 (building permit no TBD)
Address 15604 75th PI W
city Edmonds
State WA
zip 98026
Parcel No.00513100002410
Does the property currently have water service? ❑ Yes (City of Edmonds water) X No
Describe project (number of buildings, number of units, number of stories per building):
New 3000 SF, one story single family residence with attached garage
In what phase is the project?
❑ Design Review ® Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
we're working toward building permit
intake, no design review req'd (we
did pre -application meeting)
® 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 avail lity to shall not be required. Please sign below and submit this form
through www.MyBuildingaerm.
❑ For all other perm' � es, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE:
APPLICANT PRINTED NAME: Jack Bader
DATE:8 March 2023
Form Updated 12/9/2021