ENG2023-0494_Utility_Application_10.2.2023_10.19.47_AM_3815184RECEIVED
Oct 09 2023
of EDA,1
"'VC. 1890
SECTION A
CITY OF EDMONDS
DEVELOPMENT SERVICES
DEPARTMENT
WATER 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 — Water Main.
Applicant Information
Contact/Applicant Name S
r
Phone Number Jo& -- U 7t
Email r,-/S ° ' Ci../C 6
Address 0•7 - w au
City ' L-1A)6
State
Zip
Property Information
Project Name lq4ARI
Address /0_,-)- %AVE
City _ .O + State W %a
Zip y
Parcel No. 1r)6)5 &&cr any 400
Does the property currently have water service? es (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
a� 570 y^ Vol -/-S 5 /d 3 y s /Ck-
In what phase is the project?
❑ Design Review Building Permit [A)) Y' Cc V) S '4-1-Ue-4I 0P7
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: 65L D ,�V.), Q S' J 3
E I 'av'q ( --0.x l
SECTION B :2 0 a 1 _ 0,;),
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 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: 1% i /r"a,2Ak 1 DATE: ` r� L72 j
APPLICANT PRINTED NAME: V/ll %Lir 14AR61 S
Form Updated 3/28/2023