ENG2023-0624_WATER AVAILABILITY APPLICATION_12.5.2023_6.21.29_PM_3936171of 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 Mark Trembach
Phone Number
701 GGO 9422
Email
mark@marcorpcie5iejn.com
Address
8G00 25th Ave 5W, Apt 8315
City
Seattle
State WA
Zip 981OG
Property
Project Name
Litvinchuk Residence
Address
15810 715t Ave W
City
Edmonds
State WA
Zip 9802G
Parcel No.
00513300003GO4
Does the property currently have water service? ❑ Yes (City of Edmonds water) ® No
Describe project (number of buildings, number of units, number of stories per building):
New 2-5tory 5mcile family house with a davliaiht basement on a vacant lot
In what phase is the project?
x❑ Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: 13LD2023-042G
SECTION B
Exemptions from Utility Availabilit
units or less with combo water/fire
check one of the following:
RECEIVED
DEC 05 2023
CITY OF EDMONDS
L)EVELUHMENT
SERVICES DEPARTMENT
residence; 2) Multi -family project of four
7ision (four single-family lots or less). Please
0 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 SIGN.
APPLICANT PRINTED
Mark Trembach
DATE: 12/5/2023
Form Updated 3/28/2023