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ENG2024-0021_Utility_Application_1.10.2024_1.33.58_PM_3993087
of EDAgDNO� SECTION A SEWER AVAILABILITY APPLICATION 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 425 678 1465 Email austin@village-life.net Address 19020 33rd Ave W Suite 450 City Edmonds State WA Zip 98036 Property Project Name Imbery Address 8427 tooth St SW City Edmonds State WA Zip 98026 Parcel No. 27041900211400 Does the property currently have sewer service? R Yes (City of Edmonds sewer) ❑ No Describe project (number of buildings, number of units, number of stories per building): singe tamily residence, two stories In what phase is the project? RECEIVED ❑ Design Review © Building Permit JAN 10 2024 ❑ Preliminary Plat ❑ Rezone or Other CITY OF EDMONDS Associated permit application number(s), if applicable: DEVELOPMENT SERVICES DEPARTMENT 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: ^"Zzd&4L .rL DATE: 1/10/2024 APPLICANT PRINTED NAME: Austin Anderson Form Updated 3/28/2023