ENG2023-0564_Utility_Application_11.3.2023_8.46.59_AM_3879203RECEIVED
of EDAgDNO�
SECTION A
SEWER AVAILABILITY APPLICATION
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 — Sanitary Sewer Main.
Applicant
Contact/Applicant Name Austin Anderson
Phone Number 425-791-1056
Email austin@village-life.net
Address 19020 33rd Ave W Suite 450
City Lynnwood
State WA
Zip 98036
Property
Project Name BLD2023-1355 (Fulkerson)
Address 8503 tooth St SW
City Edmonds
State WA
Zip 98026
Parcel No. 27041900202900
Does the property currently have sewer service? N Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
Single family home, 2 stories
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
® Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
BLD2023-1355
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:
® 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 complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: '4l,c�_ ' g'6�0` DATE: 11/1/2023
APPLICANT PRINTED NAME: Austin Anderson
Form Updated 3/28/2023