ENG2023-0468_Sewer Availability Application_9.12.2023_2.10.05_PM_3778518RECEIVED
WATER AVAILABILITY APPLICATION
Sep 12 2023
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
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 — Water Main.
SECTION A
Applicant Informat-loi-i
Contact/Applicant Name
Phone Number 2 ✓ D &
Email 1 i CL
t c� aL 1 L'1 r �' C c� t I -LA
Address
City G� _
State Gin
Zip
Property Information
Project Named i "\ i (1 I �j ✓t 5, _ j Y�o i, 7 ��
Address
city
State
zip
Parcel No. (. ( 3- ( 2 16
Does the property currently have water service? es (City of Edmonds water) ❑ No
Proposed Development
In what phase is the project?
Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: L �J Z %
SECTION B
Exemptions from Utility Availability Study: 1) Single-family residence; 2) Multi -family project of four
units or less with combo water/fire lines; 3) Short plat subdivision (four single-family lots or less). Please
check one of the following:
PA 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.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through www.MyBuildingPermit.com.
APPLICANT
APPLICANT
7—F-:;,
Form Updated 3/28/2023