ENG2023-0495_Utility_Application_9.29.2023_1.05.30_PM_3812861ov EVA,U
ANC. 1 S9J
SECTION A
SEWER AVAILABILITY APPLICATION RECEIVED
SEP 29 2023
Complete and submit this form through Submit as a
new application using the following prompts: Application Type — Utilities. ACLIVIty
Type — Utility Availability, Scope of Work — Sanitary Sewer Main, CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Contact/Applicant Name -7- UZ-7-OW
Phone Number 42 � 7 _ 44- D
Email ,
Address
630 / 2 !-N E
City L
State
Zip
Project Name VL7� G,'4Q4 —0
Address 16 45 \4e is
City
State
Zip 4
Parcel No. Q 040 9/ ®fit+ O !Q D
Does the property currently have sewer service? es (City of Edmonds sewer) o No
Describe project (number of buildings, number of units, number of stories per building):
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
Building Permit PHtjtj _
❑ 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; 3) Short plat subdivision (four single-family lots or less). Please check one of the following:
XA utility availability study IS N T 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 Xv ,, ,.� . Mi -B,-ildin,Perniit.c,wii.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through �NT \,,%-..X1vB .u1,din I'ermit.ccm.
APPLICANT
APPLICANT
;J 2DZ3
Form Updated 3/28/2023