REVIEWED BLD2021-0088+Sewer_Availability_Cert+6.7.2021_11.59.05_AM+2235249�O� 1, A,
4 SEWER AVAILABILITY
CERTIFICATE
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PERMITTING & DEVELOPMENT
ENGINEERING
DIVISION
121 5th Avenue N
P: 425.771.0220
www.edmondswa.gov
ITEMS IN THIS BOX TO BE FILLED IN BY APPLICANT
N Building Permit ❑ Preliminary Plat or PUD
❑ Subdivision ❑ Rezone or Other
Applicant's name: Robert Hill
Proposed Use: Retirement Home (building permit not yet applied)
Location (attach map and legal description if necessary): 21200 72nd Ave W
Updated on 31312017 Page I of 2
Permit Number n/A Project Name Senior Living Development
® a. Sewer service will be provided by side sewer connection only to an existing 8" size sewer
main that is 112 feet from the site.
OR
❑ b. Sewer service will require an improvement to the sewer system of:
❑ (1). feet of sewer main to reach the site; and/or
❑ (2). The construction of a collection system on the site; and/or
❑ (3). Other (describe):
2. ® a. The sewer system is in conformance with a City approved sewer comprehensive plan.
OR
❑ b. The sewer system improvement will require a sewer comprehensive plan amendment.
(This will cause a delay in permit issuance and approval.) _
3. ® a. The proposed project is within the corporate limits of the City, or has been granted Boundary
Review board approval for extension of service outside the City, or is within the City approved
service area of a private water purveyor.
OR
❑ b. Annexation or Boundary Review Board approval will be necessary to provide service.
SEWER AGENCY CERTIFICATION
COMMENTS/CONDITIONS:
I hereby certify that the above information is true. This certification shall be valid for one year from
date of signature.
City of Edmonds Gregory Malowicki
(Agency Name) Signatory Printed Name
Associate En ineer
(Title) (Signature/Date)
Updated on 31312017 Page 2 of 2