BLD2022-0750+Water_Availability_Certificate+7.7.2022_11.15.16_AM+2975350``A-( of EDAjo4O-
WATER AVAILABILITY APPLICATION
Complete and submit this form through mmmAyBvildillgPermit corn.
INC. i $90
SECTION A
Applicant Information
Contact/Applicant Name
Phone Number ZGJ
Email mavia 6) to LOQSfQJ Aa ,
Address Dq5 & �mz" c5.
city lle- vu e,
I state
zip q90010
Properk, Information
Project Name fibedallae-
Associated Permit Number
Address `7 915 5 W
city 8TdM0r1C4'5
I State WA zip '3?0d
Parcel No. 0 q D O 0
Does the property currently have water service? o Yes (City of Edmonds water) o No
Describe project (number of buildings number of units, number of stories per building):
In what phase is the project?
❑ Design Review 5kBuilding Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable:
t
Applicability
R1 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.MyBuildingPennit.c:om.
a For all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
APPLICANT SIGNATURE: ,A6e6k� DATE: 6/22/22
APPLICANT PRINTED NAME: Niran Abedalla
Form Updated 12/9/2021