ENG2023-0414 WATER AVAILABILITY CERTIFICATERECEIVED
of EVA4o
SECTION A
Aug 16 2023
CITY OF EDMONDS
WATER AVAILABILITY APPLICATION DEVELOPMENTDEPARTMENRVICES
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.
Applicant
Contact/Applicant Name Patrick Acierto
Phone Number 206-837-2541
Email atricka mckinstr .com
Address 5005 3rd Ave S
city Seattle state WA
zip 98134
Property
Project Name Edmonds Medical Plaza
Address 21616 76th Ave W
city Edmonds
state WA
z1P 98026
Parcel No.
Does the property currently have water service? ® Yes (City of Edmonds water) 11 No
Describe project (number of buildings, number of units, number of stories per building):
In what phase is the project?
® Design Review
0 Preliminary Plat
M Building Permit
M Rezone or Other
Associated permit application number(s), if applicable:
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:
0 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.
W 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 SIGNATURE: &4 4Z6 DATE: 8/14/2023
APPLICANT PRINTED NAME: Patrick Acierto
Form Updated 3/28/2023
SECTION C
i. 0 a. Water will be provided by service only to an existing 6" cast iron (size) water
main that is 6 (feet) from the site.
OR
❑ b. Water service will require an improvement to the water system of:
❑ (1). feet of water main to reach the site; and/or
❑ (2). The construction of a distribution system on the site; and/or
❑ (3). Other (describe)
2. 0 a. The water system is in conformance with a City approved water comprehensive plan.
OR
❑ b. The water system improvement will require a water comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.)
3. 0 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.
4. 0 a. Water is/or will be available at the rate of flow and duration indicated below at no less than
20 psi - Measured at the nearest fire hydrant 6 feet from the building/property
(or as marked on attached map)
Rate of Flow Duration
❑ Less than 500 gpm. (approximately gpm) ❑ Less than one (1) hour
❑ 500 to 999 9Pm
❑ 1500 gpm or more
❑ One (i) to two (2) hours
❑ Two (2) hours or more
❑ Flow test of gpm ❑ Other
0 Calculation of 1540.09 gpm (Commercial building permits require flow test or
calculation)
OR
❑ b. Water system is not capable of providing fire flow.
Water Agency Certification
Comments/Conditions:
Static Pressure: 75.47 psi
Pressure at Available Flow: 65.01 psi
Maximum Flow: 1540.09 gpm
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
Jenelle Ho
(Agency Name)
(Signatory Printed Name)
Associate Engineer
r ' Digitally signed by Jenelle Ho
DN: C=US, E=jenelle.ho@edmonds—gov, O=The
Jenelle Ho City of Edmonds, OU=Engineering, CN=Jenelle Ho
Date: 2023.09.25 13:18:18-0700'
(Title)
(Signature/Date)
Form Updated 3/28/2023
RECEIVED
CITY OF EDMONDS MBuildingPermit
Utilities Application #1362526 - Edmonds Medical Plaza
Aug 16 2023
CITY OF EDMONDS
tom DEVELOPMENT SERVICES
DEPARTMENT
Applicant
First Name Last Name Company Name
Rob Fix McKinstry Co
Number Street Apartment or Suite Number E-mail Address
5005 3rd Ave S PO Box 24567 permits@mckinstry.com
City State Zip Phone Number Extension
Seattle WA 98134 (206) 790-1091
Contractor
Company Name
MCKINSTRY CO LLC
Number Street Apartment or Suite Number
5005 3rd Ave S PO Box 24567
City State Zip Phone Number Extension
Seattle WA 98134 (206) 762-3311
State License Number License Expiration Date UBI # E-mail Address
MCKINCL942DW 3/16/2024 FD9.iRgg99 permits@mckinstry.com
Project Location
Number Street Floor Number Suite or Room Number
21616 76TH AVE W
City Zip Code County Parcel Number
EDMONDS 98026 00461000100101
Associated Building Permit Number Tenant Name
Edmonds Medical Plaza
Additional Information (i.e. equipment location or special instructions)_
Work Location
Property Owner
First Name Last Name or Company Name
HR ACQUISITION I CORPORATION
Number Street Apartment or Suite Number
PO BOX 92129
City State Zip
SOUTHLAKE TX 76092
Certification Statement - The applicant states:
I certify that I am the owner of this property or the owner's authorized agent. If acting as an authorized agent, I further certify that I have full power and
authority to file this application and to perform, on behalf of the owner, all acts required to enable the jurisdiction to process and review such application. I
have furnished true and correct information. I will comply with all provisions of law and ordinance governing this type of application. If the scope of work
requires a licensed contractor to perform the work, the information will be provided prior to permit issuance.
Date Submitted: 8/15/2023 Submitted By: Rob Fix
Page 1 of 2
CITY OF EDMONDS M BuildingPermit.com
Utilities Application #1362526 - Edmonds Medical Plaza
Project Contact
Company Name: McKinstry Co
Name: Rob Fix Email: permits@mckinstry.com
Address: 5005 3rd Ave S PO Box 24567 Phone #: (206) 790-1091
Seattle WA 98134
Project Type Activity Type Scope of Work
Nonresidential Utility Availability Water Main
Project Name: Edmonds Medical Plaza
Description of Work: Water Supply information is needed.
Project Details
Project Information
Connection to City water service
Page 2 of 2