REVIEWED Water Availability Form+1.24.2022_11.03.20_PM+2638860of EDkJ0���
WATER AVAILABILITY APPLICATION
Complete and submit this form through ivw-vv.MyBuildingPermit com.
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SECTION A
Contact/Applicant Name 1 1`S t / j
Phone Number _ 2 Q _ '7 1/ l
Email rt:c tar i16LZ,- vL 5'
Address
City
Project Name U
f J A C
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Associated Permit Number
Address 1
7
City 6 D
%./ 0 S I State W4 1 Zip qgG 4
Parcel No. O G
7- a 00 120
Does the property currently have water service? 13 Yes (City of Edmonds water) o
Proposed Developinent
Describe project (number of buildings number of units number of stories per building):
A/F_ cV S/''
In what phase
hase is the project?
[! Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
19' 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 r,Nww.MvBuildingPermit.com.
❑ For all other permit types, a uta;availabillidy is re ired and associated fees will be due. Please
submit the complete application thdin rmit.cotia.
APPLICANT SIGNATURE:d ,p DATE::
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APPLICANT PRINTED NAME: R 1 � S A (Skim
Form Updated 12/9/2021