ENG2023-0220_Utility_Application_4.19.2023_9.24.23_AM_3491652Of EVAfo
ANC. 100
SECTION A
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildin&Pennit.com. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Water Main.
Contact/Applicant Name Ed Mecum
Phone Number 425-364-5285
Email edm@g2civii.com
Address 1700 NW Gilman BLVD., Suite 200
city Issaquah
state Wa
zip 98027
Property 1nfornu,1ti0T1
Project Name I ouse
Address 7815 202nd PL SW
_
city Edmonds I
state Wa
zip 98026
Parcel No. 00401300000400
Does the property currently have water service? X Yes (City of Edmonds water) c No
Describe project (number of buildings, number of units, number of stories per building):
Construction of one single family residence
In what phase is the project?
❑ Design Review IN Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: B1 D2022-0750
SECTION B
nce; 2) Multi -family project of four
(four single-family lots or less). Please
check one of the following:
® A utility availability study IS- 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 M requested/required for the project, and associated fees will be
due. Please submit the compIckrgppjAoSon through www.MyBuildiniEPermit.com.
APPLICANT
APPLICANT PRINTED NAME: L--%t AAb
Form Updated 3/28/2023