Sewer Availability Certification 22617 76th Ave WRECEIVED
of EDAgDNO�
SECTION A
Mar 11 2024
CITY OF EDMONDS
SEWER AVAILABILITY APPLICATION DEVE OPMENT
EPARTMENRVICES
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
Chris Davidson, AIA
Phone Number
253.337.1055
Email
chris@JCRCollective.com
Address
950 Broadway, Suite M-100
city
Tacoma
I state WA
zip 98402
Property
Project Name
Stone Court
Address
22617 76th AVE W
City
tdmonds
state WA
zip 98026
Parcel No.
27042900308600
Does the property currently have sewer service? X Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
Existing Building w/ a proposed project to convert 6 office spaces to residential units and convert 2-3
office spaces to church office space that will be used for offices and small gatherings
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.
C449-1-
APPLICANT SIGNATURE: DATE: 3/6/2024
APPLICANT PRINTED NAME: Chris Davidson, AIA
Form Updated 3/28/2023
SECTION C
OR
a. Sewer service will be provided by side sewer connection only to an existing
size sewer main that is ° feet from the site.
❑ b. Sewer service will require an improvement to the sewer system of-
8 Inch
❑ (i). feet of sewer main to reach the site; and/or
❑ (2). The construction of a collection system on the site; and/or
❑ (3). Other (describe)
2. LJ a. The sewer system is in conformance with a City approved sewer comprehensive plan.
OR
❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.)
3. e a. The proposed project is within the corporate limits of the City, or has been granted
Boundary Review board approval for extension of service outside the City, or is within the City approved
service area of a private water purveyor.
OR
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
Sewer Agency Certification
Comments/Conditions:
There is an existing City of Edmonds sewer manhole at the northeast corner of 22617
76th Ave W. The manhole is approximately located at the property line.
I hereby certify that the above information is true. This certification shall be valid for one year from the date of signature.
City of Edmonds
Jenelle Ho
(Agency Name)
(Signatory Printed Name)
Associate Engineer
Ogllally s.g,,d by Je,- H,
Jenelle Ho Ea b °�=EIa-111g,C.nee111H, ^eOTyo1
Oaie'. 202J.03.13 08'.56:40.07'00'
(Title)
(Signature/Date)
Form Updated 3/28/2023