ENG2023-0538+Utility_Application+10.20.2023_1.49.53_PM+3852858-LFof EDA40�V
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INC. i S'� J
SECTION A
SEWER 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.
Applicant
Contact/Applicant Name Jacob Strobl
Phone Number 206-661-3622
Email Jacob@strobldesign.com
Address 1122 N J St
City Tacoma
State WA
zip 98403
Property Information Name Hopper Residence
Address 1005 Olympic Ave
City Edmonds State WA zip 98020
Parcel No. 00770700002100
Does the property currently have sewer service? ❑ Yes (City of Edmonds sewer) $I No
Describe project (number of buildings, number of units, number of stories per building):
New two story single family residence.
In what phase is the project?
❑ Design Review X Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: _ BLD2023-1083
SECTION B
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:
x 1 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 application through www.MyBuildingPermit.com.
APPLICANT
APPLICANT PRINTED
Jacob Strobl
DATE: 10/20/2023
Form Updated 3/28/2023