ENG2023-0538_Utility_Application_10.20.2023_1.49.53_PM_3852858RECEIVED
Oct 20 2023
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SECTION A
CITY OF EDMONDS
SEWER AVAILABILITY APPLICATION DEVE OPARTMENRVICES
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 Information
Contact/Applicant Name Jacob Strobl
Phone Number 206.661.3622
Email Jacob@strobldesign.com
Address 1122 N J St
City Tacoma
State WA
zip 98403
Property• •
Project Name Hopper Residence
Address 1005 Olympic Ave
City Edmonds State WA zip 98020
Parcel No. 00770700002100
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) X No
Describe project (number of buildings, number of units, number of stories per building):
New two story single family residence.
In what phase is the project?
❑ Design Review 1 x Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: _ BLD2023.1083
SECTION B
Applicability
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:
x 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.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the rnmn1PtP annliratinn through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: DATE: 10/20/2023
APPLICANT PRINTED NAM'.. Jacob Strobl
Form Updated 3/28/2023