ENG2023-0187_City_Application_4.5.2023_12.19.02_PM_3464726RECEIVED
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SEMON A
SEWER AVAILABILITY APPLICATION APR 05 2023
Complete and submit this form through ������.:►Ivi3u�ilinbPermit.i �m
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Applicant Informition
Contact/Applicant Narnr ,W 1 /�•yRS
Phone SuniNs 06 7 9 Q l
Entail r �rS_�� • CC
Addrr..v W5-y6�o��r�
City �cQ/Na Stair � %p dil
Propeftv r
PM;cr.•t r:,n1,• _t✓,�/S%/(S_S'�og� !°cAT � _
A.wxiated Pennit Numlxv 10 Z QO Q
Addn�c Z� /`O/iSy%/l 44 City stme
Parcel S(r. ? 70 ;,Z SO 0.213 00
hoc% Ihr pcoperti carnittly hay c sewer unice? )6'cs (City of FAMCA& %rwrr) O No
Do.wribe project (number of buildings, nu tuber of unit., numlvT of stories perbuilding):
Iz
In what phase is (tic project?
❑ Design Review
Preliminary flat
❑ Building Permit
❑ Rtvone or Othcr
:lssaciated lx'rrnit applirltion number(s), if applicable: =NZO.2Z " OD y0
SEMON B
KApplicant certifies that this project is a single-family residence, multi -family project of four units or
less, orshort plat subdivision (four sing le -family lots or less), in which case completion of a full utility
avalilahility study shall not be required. Please sign below and submit this form through
c�zne,yl�•Rn ildin�;PCI"II11LlY1i11.
❑ For all other permit types, a utility availability study is required and associated fees %%ill he due. Please
:submit the complete application throng h L%,% w- NlyB, tildipg1lermit.com.
:U'1'1.ICA` i'SIGVATURE: Y n:1TE:_jl� Jj'/,�U
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Form Updated 12/9/2021