ENG2023-0237 SEWER AVAILABILITY CERTIFICATEOE EDA40
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SECTION A
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Sanitary Sewer Main.
Applicant•
Contact/Applicant Name
Phone Number �( 2S - �p'} 3 _ 101
Email Yhh e wtA-W t}—Q. - (( Ow\
Address ,O Z.p �4�� � t p I
City S
State V`)
Zip
Property Inf• •
Project Name �n
Address
City
State VV
Zip
Parcel No.
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) eo
Describe project (number of bpildings, number of units, number of stories per building):
In what phase is the project?
❑ Design Review F!�r Building Permit
-RECEIVED
MAY 01 2023
❑ Preliminary Plat ❑ Rezone or Other CITY OF EDMONDS
2023 � DEVELOPMENT
Associated permit application number(s), if applicable: ~ 6 Ll qq SERVICES DEPARTMENT
SECTION B
Exemptions from Utility Availability Study: 1) Single-family residence; 2) Multi -family project of four
units or less; 3) Short plat subdivision (four single-family lots or less). Please check one of the following:
❑ A utility availability study IS NOT requested/required. The applicant certifies that this project
is exempt from needing a study as described above and is not requesting a full utility availability
study at this time. Please sign below and submit this form through www.MyBuildingPermit.com.
JLP A utility availability study IS requested/required for the project, and associated fees will be
`ue. Please submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE. DATE: 7i
APPLICANT PRINTED NAME:
Form Updated 3/28/2023
SECTION C
1. a. Sewer service will be provided by side sewer connection only to an existing 8" Clay Gravity
size sewer main that is 10 feet from the site.
OR
❑ b. Sewer service will require an improvement to the sewer system of:
❑ (1). feet of sewer main to reach the site; and/or
❑ (2). The construction of a collection system on the site; and/or
❑ (3). Other (describe)
2. a. The sewer system is in conformance with a City approved sewer comprehensive plan.
OR
❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.)
3. El a. The proposed project is within the corporate limits of the City, or has been granted
Boundary Review board approval for extension of service outside the City, or is within the City approved
service area of a private water purveyor.
OR
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
Se�N,cr,\gency Certification
Comments/Conditions:
Sewer service connection shall be made to existing 8"
northwest of property.
clay gravity main in alley to the
I hereby certify that the above information is true. This certification shall be valid
for one year from the date of signature.
City of Edmonds - Engineering
(Agency Name)
Russell Lynch
(Signatory Printed Name)
Associate Engineer
(Title)
9/11 /2023
Si nature Date
Form Updated 3/28/2023