ENG2023-0135_Utility_Application_3.9.2023_12.09.25_AM_3410428RECEIVED
MAR 09 2023
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SEWER AVAILABILITY APPLICATION CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
- Complete and submit this form through www.MyBuildingPermit.com.
INC. 13a 0
SECTION A
Applicant
Contact/Applicant Name Motionspace Architecture + Design (contact: Jack Bader)
Phone Number - -
Email Jac mo Ion-space.com
Address 3104 Western Ave #107
city Seattle
State WA zip 98121
Property Information KO esl ence
Associated Permit Number -
(building permit no
Address 15604 75th
City Edmonds
State WA
zip
Parcel No. 00513100002410
Does the property currently have sewer service?
❑ Yes (City of Edmonds sewer) XNo
Describe project (number of buildings, number of units, number of stories per building):
New , one story singe tamily residence with attached garage
In what phase is the project?
we're working toward building permit
❑ Design Review IN Building Permit intake, no design review req'd (we
did pre -application meeting)
❑ Preliminary Plat ElRezone or Other
Associated permit application number(s), if applicable:
SECTION B
IN 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 re red P1F- e sign below and submit this form through
www.M Buildin Permit n.
❑ For all other permit Lypes, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: DATE: 8 March 2023
APPLICANT PRINTED NAME: Jack Bader
Form Updated 12/9/2021