ENG2023-0186_Utility_Application_4.5.2023_12.32.41_PM_3464787RECEIVED
NVATER AVAILABILITY APPLICATION APR 05 2023
Complete and submit this furor through -*%,.z+•.,%Iyll� _ uildin,Permit.cs.
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CITY OF EDMONDS
•C1340 DEVELOPMENT
SERVICES DEPARTMENT
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Applicant Information
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Proposed Development
Describe project (number of buildings, number of units, number of stories per building):
2,47
In what phas- is the proja-t?
❑ Design Reviet+• ❑ Building Permit
JV Preliminary Plat ❑ Rezone or Other
. %sociated permit application number(s), if applicable: -A, A (-3 — 6<3 YO
SECTION B
Applicant mrtifies that this project is a sinvJe-family residence, mull i-fa mily project of four units or
less %%ith combo water/fire lines, 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 MyBuilflinbl'ermit.com,
❑ For all other permit tyres, a utility availability study is required and w"Nociated fees will be due. Please
submit the complete application through +�+�+.�I� 13uildinePerinit com,
APPLICANTSIGNATURF:: �� L� DACE.:
APPLICANT• PRINTED NA.`tl: t%r�' f=/7/iS•
Form Updated 12/9/2021