SEWER AVAILABILITY APPLICATIONRECEIVED
Nov 22 2023
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SECTION A
CITY OF EDMONDS
SEWER AVAILABILITY APPLICATION DEVELOPMENT SERVICES
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 Austin Anderson
Phone Number 425-678-1465
Email austin@village-life.net
Address 19020 33rd Ave W Suite 450
City Lynnwood
State WA
Zip 98036
Property • •
Project Name Talbot Rd
Address 17626 Talbot Rd
City Edmonds
State WA
Zip 98026
Parcel No. 00594400003401
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) RI No
Describe project (number of buildings, number of units, number of stories per building):
single family home, 2 stories
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. 4ud�&� DATE: 11/22/2023
APPLICANT PRINTED NAME: Austin Anderson
Form Updated 3/28/2023