ENG2023-0219_Utility_Application_4.19.2023_9.21.21_AM_3491621SEWER 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.
SECTION A
Applicant Inforniatimi
Contact/Applicant Name Ed Mecum
Phone Number 425-364-5285
Email EdM@g2civil.com
Address 1700 NW Gilman BLVD., Suite 200
city Issaquah
state wa
zip 98027
Property ITIforniation
Project Name All House
Address 7815 202nd PL SW
city Edmonds
I state wa
zip 98026
Parcel No. 00401300000400
Does the properly currently have sewer service? )0 Yes (City of Edmonds sewer) o 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
❑ Preliminary Plat
N Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable
SECTION B
Exemptions from Uti]
units or less; 3) Short
BLD2022-0750
.udy: 1) Single-family residence; 2) Multi -family project of four
(four single-family lots or less). Please check one of the following:
N 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 a cati n through www.MyBuildin,&Permit.com.
APPLICANT SIGNATUR DATE: r L3
APPLICANT PRINTED NAME: bAtIAM, 1'C�
Form Updated 3/28/2023