ENG2023-0219+Utility_Application+4.19.2023_9.21.21_AM+3491621-LFSEWER 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.
SECTION A
Applicant Inforniatimi
Contact/Applicant Name Ed Mecum
Phone Number 425-364-5285
Email EdM@g2civil.com
Address 1700 NW Gilman BLVD., Suite 200
city Issaquah
state wa
zip 98027
Property Information
Project Name Ali House
Address 7815 202nd PL SW
city Edmonds
I State wa
Izip 98026
Parcel No. 00401300000400
Does the property currently have sewer service? )0 Yes (City of Edmonds sewer) ❑ No
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
❑ Preliminary Plat
N Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
BLD2022-0750
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:
N 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 a cati n through %-%w.MyBuildingPermit.com.
1
APPLICANT SIGNATU DATE: { L�
APPLICANT PRINTED NAME:�1�
Form Updated 3/28/2023