ENG2024-0020_Utility_Application_1.10.2024_12.56.13_PM_3992955of EDAg0NO�
SECTION A
WATER 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 — Water 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 Lynnwood
State WA
Zip 98036
Property
Project Name Imbe ry
Address 8427 tooth St SW
City Edmonds
State WA
Zip 98026
Parcel No.
27041900211400
Does the property currently have water service? Ii Yes (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
single family residence, two stories
In what phase is the project? RECEIVED
❑ Design Review
❑ Preliminary Plat
® Building Permit
❑ Rezone or Other
JAN 10 2024
CITY OF EDMONDS
Associated permit application number(s), if applicable: nF\/F1 OPMENT
SERVICES DEPARTMENT
SECTION B
Exemptions from Utility Availabilit
units or less with combo water/fire
check one of the following:
residence; 2) Multi -family project of four
7ision (four single-family lots or less). Please
® 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. 'A� 4,'t�'kL DATE: I/10/2024
APPLICANT PRINTED NAME: Austin Anderson
Form Updated 3/28/2023