ENG2023-0523_SEWER AVAILABILITY APPLICATIONRECEIVED
Oct 13 2023
SEWER AVAILABILITY APPLICATION
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Complete and submit this form through vvww.My_BuildinPermit.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
Appliewit Itifortuatioii
Contact/Applicant Name c, Y-c. t c L, A
` l
Phone Number v-c) '7 -7 t5
-22 -'1Email
p
'X /Or o �"G7 e Y5 6' eal ,, S c v h 5jir v G +! v Lv . c v v.,
Address 'Z U ( �/ /�'7C % a A e l- %
City '5-e-,-
I state
Zip 1 j
Property hiforimitioii
Project Name 6 Zi -7
Address 6 - -7
City
State /
Zip
Parcel No. oo 41 Z' j Z' 1 CJ 0
Does the property currently have sewer service? ZYes (City of Edmonds sewer) ❑ No
Proposed Development
Describe project (number of buildings, number, eof units, number of stories per building):
et � GY#'�// `i i1 t! �C�f/I CX 1/✓7!!/}?/t
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
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 complpte application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE:?92 DATE: l� 3 O Z3
APPLICANT PRINTED NAME: (3 ® r c 1 C-''1
Form Updated 3/28/2023