REVIEWED BLD2021-1719+WATER AVAIL +1.3.2022_11.37.50_AM+2599653LOT 2
Ll�
W
fy
C`7
O
N
N
N
0')
SECTION A
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
51.10►
I MUM I
Applicant Information
Contact/Applicant Name Select Homes, Inc.
Phone Number 425.742.6044
Email kayla.clark@outook.com
Address 8304 212th St. SW
City Edmonds
State WA
Zip 98026
Property • •
Project Name 7948 203rd 2 lot short plat - lot 2 SFR 7922 2 0 3 3 RD S T SW LOT 2
Associated Permit Number BLD2021-1719
Address 791 203rd St. SW.
City Edmonds
State WA
Zip 98026
Parcel No. 27041900112700
Does the property currently have water service? R Yes (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
One 2 story single family residence
In what phase is the project?
El Design Review
El Building Permit
El Preliminary Plat El Rezone or Other
Associated permit application number(s), if applicable: BLD2021-1719
SECTION B
Kayla Nichols, Select Homes, Inc.
[A 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.MyBuildingPermit.com.
El 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: 1.3.22
IV
APPLICANT PRINTED NAME: Kayla Nichols, Select Homes, Inc.
Form Updated 12/9/2021