DNS - BLD2022-0381+SEWER AVAIL+3.31.2022_5.14.12_PM+2774834of EhA1p�0
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
Ilk 1890
SECTION A
Applicant
Contact/Applicant Name M�
Phone Number ZPE
Email ;'� ,nM�-�Ca ✓✓, �. C v•'�
Address
City State ,a Zip
{- G
Property
Project Name _T
Associated Permit Number Z-7
Address r , Y
City i ) ^ 6� �j State j zip
Parcel No. ��; • •7
Uo7 GD
Does the property currently have sewer service? pYes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
S,�a: e_e— '1�C�r� � istc e�� �IU. � �.of "'il/ `'Le— ✓�1'�, ��
/ ,T 4: 1) 6 " n2'- l o e -: f-e d ✓ i S J.6f ec. f' is—Y-Z-4�
In what phase is the project?
❑ Design Review 2) Building Permit
❑ Preliminary Plat ❑ Rezone or Other h Associated permit application number(s), if applicable: 0 Z0Z!Z_ 03 T 1
SECTION B
El' Applicant certifies that this project is a single-family residence, multi -family project of four units or
less, or short plat subdivision (four single-family lots or less), in which case completion of a full utility
availability study shall not be required. Please sign below and submit this form through
www.MyBuildingPermit.com.
❑ For all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through wwwZl BuildingPermit.com.
APPLICANT SIGNATURE: DATE: r� z--
APPLICANT PRINTED NAME: /t%C„h ��m,►�
Form Updated 12/9/2021