DNS BLD2022-0287+WaterAvilabilityApp+3.10.2022_10.48.30_AM+2729743�41-1 of E L XF0,40
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
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SECTION A
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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 Zilz 98036
Project Name Echelbarger - 92nd
Associated Permit Number BLD2022-0287
Address 21322 92nd Pi. W
City Edmonds State WA
ZiP 98020
Parcel No. 00479300000600
Does the property currently have water service? ❑ Yes (City of Edmonds water) 16 No
Describe project (number of buildings, number of units, number of stories per building):
1 single family home, 2 stones
In what phase is the project?
❑ Design Review 0 Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
V 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 availability study shall not be required. Please sign below and submit this form
through www.MyBuildin&Permit.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: ATE-
APPLICANT PRINTED NAME: Todd Echelbarger
Form Updated 12/9/2021