ENG2024-0482 SEWER AVAILABILITY CERTIFICATEof ED&JO'tb
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"'VC. 1 S90
SECTION A
SEWER AVAILABILITY APPLICATION
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
Phone Number
Email VAnW" wed ti^-t . �M
Address 3u 1 �'\
City %I
State
Zip Ol�
Property Information
Project Name h U `1WA
Address �So p
City ,A��
State (v
Zip
Parcel No.
Does the property currently have sewer service? 6-Yes (City of Edmonds sewer) ❑ No
Proposed Development
ect (number of buil'number of units umber of stories
��ct
In what phase is the project?
❑ Design Review
❑ Building Permit
Preliminary Plat El Rezone or Other
Associated permit application number(s), if applicable: lIm Z t 2q - b 0 4b
SECTION B
RECEIVED
OCT 07 2024
CITY OF EDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
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 fall 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 511 DATE: y Z�
APPLICANT PRINTED NAME:�Tt 9
Form Updated 3/28/2023
SECTION C
OR
a. Sewer service will be provided by side sewer connection only to an existing
that is 2 feet from the site.
❑ b. Sewer service will require an improvement to the sewer system of:
sewer manhole
❑ (1). 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:
Connect to existing manhole 4-29.
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
DlgAally signed 1, Jenelle Ho
DN: C=US, E=lenelle.ho@edmondswa.gov, O=The City of
ene e O
Edmonds, OU=Engineering, CN=Jenelle Ho
Date: 2024.10.1 O 12:44:18-OTOO'
(Title)
I (Signature/Date)
Form Updated 3/28/2023