ENG2024-0082_City_Application_2.22.2024_9.59.10_AM_4075432RECEIVED
of EDAgDNO�
SECTION A
Feb 22 2024
SEWER AVAILABILITY APPLICATION CITY E
DEVELOPMM ENTT SSERVI ERVICES
DEPARTMENT
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 Information
Contact/Applicant Name Joseph Rowett for Landsverk Quality Homes, Inc.
Phone Number 425-760-9218
Email joseph@lqh-inc.com
Address 24113 56th Ave W
city Mountlake Terrace
State WA
zip 98043
Property• •
Project Name Talbot Lot A
Address 7925 Cyrus LN
city Edmonds
State WA
Zip 98026
Parcel No.
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) KNo
Describe project (number of buildings, number of units, number of stories per building):
2 story single family residence
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
® Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
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:
® 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: Joseph Rowett DATE: 2/22/2024
Joseph Rowett
APPLICANT PRINTED NAME:
Form Updated 3/28/2023