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SECTION A
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 Ed Mecum
Phone Number 425-364-5285
Email edm@g2civil.com
Address 1700 NW Gilman BLVD., Suite 200
city Issacivah
state wa zip 98027
Property Information
Project Name X11i ouse
Address 7815 202nd PL SW
_
"ty Edmonds
I state wa
zip 98026
Parcel No. 00401300000400
Does the property currently have water service? X Yes (City of Edmonds water) C No
Proposed Development
Describe project (number of buildings, number of units, number of stories per building):
Construction of one single family residence
In what phase is the project?
❑
Design Review
IN
Building Permit
❑
Preliminary Plat
❑
Rezone or Other
Associated permit application number(s), if applicable: BLD2022-0750
SECTION B
EMMMM
Exemptions from Utility Availability Study: i) 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-- 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•.MyBuildingPer-mit.com.
❑ A utility availability study M requested/required for the project, and associated fees will be
due. Please submit the comp
,4 iWIpplia#96n through www.MyBuildingPermit.com.
APPLICANT SIG
APPLICANT PRINTED NAME: L-%" vAkb M
M
Form Updated 3/28/2023