ENG2023-0578+SEWER AVAILABILITY APPLICATION+11.7.2023_8.41.50_AM+3885154-LFof EDA40�V
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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 Austin Anderson
Phone Number 425_678_1465
Email austin@village-life.net
Address 19020 33rd Ave W Suite 450
City Lynnwood
State WA
Zip 98036
Property
Project Name Spence Lot 2 PLN 20170057
Address 176o6 72nd Ave W
City Edmonds
State WA
Zip 98026
Parcel No. 00513600000loo
Does the property currently have sewer service? [i Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
single family home, 2 stories
In what phase is the project? RECEIVED
❑ Design Review 0 Building Permit NOV 7 2023
❑ Preliminary Plat ❑ Rezone or Other
CITY OF EDMONDS
DEVELOPMENT
Associated permit application number(s), if applicable: SERVICES DEPARTMENT
SECTION B
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:
❑x 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: 4ada rL'4464Aa-&/y DATE: 11 /7/2023
APPLICANT PRINTED NAME: Austin Anderson
Form Updated 3/28/2023