ENG2023-0524_WATER AVAILABILITY APPLICATIONRECEIVED
Oct 13 2023
WATER AVAILABILITY APPLICATION
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
Complete and submit this form through vvray Mv%ttldin I'ermit.com. Submit as a
new application using the following prompts: Application Type - Utilities, Activity
Type - Utility Availability, Scope of Work - Water Main.
SECTION A
Applicant hifortriatioii
Contact/Applicant Name
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Phone Number
Email ca sP ' Ci k-L, �� r
Address -
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City
State
zip
Property• •
Project Name — v —�
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Address 7 rt
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City E ew'N -7
I State
zip 0 Z 0
Parcel No. (--., 043 G { /
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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):
?5 . -�-' "—f-
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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 with combo water/fire lines; 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,�iv-,v,IY vBttiiditi�zPerniit.coni.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through .v-�v.1VivEuil i c Perinit.coni.
APPLICANT SIGNATURE: DATE:
APPLICANT PRINTED NAME: `` C> (5 0 Y_
Form Updated 3/28/2023