ENG2024-0051 SEWER AVAILABILITY RECORD�'0 of E PAIOl-
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lNC.
SECTION A
SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildin Permit.corr. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Sanitary Sewer Main.
Information Contact/Applicant Name
S7-1 K. Low -'f LEA- eNCrL.s 1TG'G'f5.
Phone Number 1,90 V r Lt
Email ► Pr•" . GOB
Address S1
CiTy
State
zip 9 9 1V
i i-oject Name 222.GN g
Address 2,>1-40 Sv Pr
City to
State
Zip ®1�
Parcel No. 2 0525ooto a oo
Does the property currently have sewer service? 11 Yes (City of Edmonds sewer) ❑ No
Proposed Development
Describe project (number of buildings, number of units, number of stories per building):
pw s - u N 1•r '61tj .�F skMkt uy �.�oA e � 'twG �"�D R.� eS Aa 7,000 5x.
In what phase is the project?
❑ Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: vlZ'.mLl — 000 5
SECTION B
Applicability
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:
0 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.M% nuudingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through �,ww.i%!BuildingPermit.com.
i
APPLICANT SIGNATURE:
APPLICANT PRINTED NAME: J
DATE: CAL 0 i v�
Form Updated 3/28/2023