DNS BLD2022-0287+SewerAvailabilityApp+3.10.2022_10.48.30_AM+2729744. OF [VA104Ci
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPerrnit.corn.
ANC. 1390
SECTION A
Contact/Applicant Name Echelbarger Homes, Inc.
Phone Number 425,673,1100
Email Todd@Echelbarger.com
Address 4001 198th St. SW #2
City Lynnwood State WA Zip 98036
Project Name Echelbarger - 92nd
Associated Permit Number BLD2022-0287
Address 21322 92nd Pl. W
City Edmonds
State WA
7-ip 96020
Parcel No. p0479300000600
Does the property currently have sewer service? ID Yes (City of Edmonds sewer) it No
Describe project (number of buildings, number of units, number of stories per building):
t single family home, 2 stories
In what phase is the project?
❑ Design Review Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
1Z 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 required. Please sign below and submit this form through
www.MyBuildingFermit.com.
❑ For all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: DATE: 1 LZ
APPLICANT PRINTED NAME: Todd Echelbarger
Form Updated 12/9/2021