BLD2023-0401+OVWSD Sewer_Availability_Certificate_+9.15.2023_4.30.07_PM+3787083OLYMPIC VIEW WATER AND SEWER DISTRICT
8128 228" St SW, EDMONDS WA 98026
OLXMPIC VIEW (425) 774-7769
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CERTIFICATE OF SEWER AVAILABILITY
Section A: to be completed by Applicant
Owner's Name: Bernard Shen & Cathy Federman
Phone Number: (206) 954-0855
Owner's mailing address: 417 NW 132nd Street / Seattle, WA 98177
Circle one: New Construction Cemolition/New Construction
Other(Explain):
Proposed Use: Single Family Residence
Address of Property: 23310 Humber Lane / Edmonds, WA 98020
Snohomish County Tax Assessor's Parcel Number:
DO NOT WRITE BELOW
00571300101000
To be completed by Olympic View Water and Sewer District
SECTION B:
Sewer service will be provided at the edge of the public right of way adjacent to the
property by connection to an existing_ sewer main.
OR
❑ Owner/Developer is required to enter into Extension Agreement with Olympic View
Water and Sewer District to install a mainline facility extension of the Olympic View
Water and Sewer District system to the property.
OR
❑ Service will be provided at the edge of a nearby public right of way and will require
construction of a private single or multi -owner side sewer to the property.
AND/OR
Other (describe): Cot qnd CaA Sidi Sewer jJe�M i t s' yW d -�or
Reyi'or 4A ,qewar Wmli fVy'ired -Tyr c6AS` Nc4ivg.
❑ An easement exists on the property (describe):
This is not an approval of sewer service to the site. A proper application must be filed with
the District and all facility charges paid before sewer service can be provided. This
certification is valid only for the referenced use and identified owner, and expires after one
(1) year.
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Responsible Official,
OLYMPIC VIEW WATER AND SEWER DISTRICT
8128 228t6 St SW, EDMONDS WA 98026
(425) 774-7769
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pic View Water and Sewer District Date
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