ENG2023-0625_SEWER AVAILABILITY APPLICATION_12.5.2023_6.16.52_PM_3936160of 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 Mark Trembach
Phone Number
701 000 9422
Email
mark@marcorpdc5i6jn.com
Address
8000 25th Ave 5W, Apt 5315
City
Seattle
State WA
Zip 95100
Property
Project Name Litvmchuk Residence
Address 15810 715t Ave W
City Edmonds
State WA
Zip 9502G
Parcel No. 00513300003GO4
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) ® No
Describe project (number of buildings, number of units, number of stories per building):
New 2-5tory 5mgle family house with a daylight basement on a vacant lot
In what phase is the project? RECEIVED
❑x Design Review ❑ Building Permit
DEC 05 2023
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: BLD2023-042G CITY OF EDMONDS
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:
❑x 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: DATE: 12/5/2023
APPLICANT PRINTED NAME: Mark Trembach
Form Updated 3/28/2023