ENG2023-0135+Utility_Application+3.9.2023_12.09.25_AM+3410428-LFRECEIVED
MAR 09 2023
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SEWER AVAILABILITY APPLICATION CITY OF EDMONDS
DEVELOPMENT
Complete and submit this form through www.MyBuildingPermit.CO11RVICES DEPARTMENT
SECTION A
InformationApplicant Contact/Applicant NameMotionspace Architecture + Design (contact: Jack Bader)
Phone Number 206-495-5847
Email jack@motion-space.com
Address 3104 Western Ave #107
city Seattle
state WA
zip 98121
Property Information
ProjectName Koh Residence
Associated Permit Number PRE2022-0010 (building permit no TBD)
Address 15604 75th PI W
city Edmonds
state WA
zip 98026
Parcel No. 00513100002410
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) XNO
Describe project (number of buildings, number of units, number of stories per building):
New 3000 SF, one 3000 SF, one sto�sin_ single family residence with attached garage
residence with attached��ge
In what phase is the project?
❑ Design Review ❑X Building Permit we're working toward building permit
intake, no design review req'd (we
ElPreliminary Plat El Rezone or Other did pre -application meeting)
Associated permit application number(s), if applicable:
SECTION B
® Applicant certifies that this project is a single-family residence, multi -family project of four units or
less, 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.MyBuildingPermit.com.
❑ 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: SZ)6�DATE: 8 March 2023
APPLICANT PRINTED NAME: Jack baac.
Form Updated 12/9/2021