DNS - BLD2022-0381+WATER AVAIL+3.31.2022_5.12.32_PM+2774831of EDA,104'O
INC. I SCO
SECTION A
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
Applicant
Contact/Applicant Name
Phone Number
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Email
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Address S
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city
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State ,,'.� Zips/%
Property • •
Project Name
Associated Permit Number j&I l� Z-� G
Address G G
City ' ^ �� State f, zip -/ 8 o e.'. o
Parcel No. Dr, 3'7 1 '1 0 !l C(-
Does the property currently have water service? ❑ Yes (City of Edmonds water) ill No
Describe project (number of buildings, number of units, number of stories per building):
In what phase is the project?
❑ Design Review 0 Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: JSLb 'y _�' 0 /-
SECTION B
P Applicant certifies that this project is a single-family residence, multi -family project of four units or
less with combo water/fire lines, 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 www.myLluildingPermit.com.
APPLICANT SIGNATURE: DATE:
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APPLICANT PRINTED NAME:
Form Updated 12/9/2021