ENG2024-0052 WATER AVAILABILITY RECORDWATER 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 - Water Main.
SECTION A
Applicant Information
Contact/Applicant Name SVK L — Ti��.
1
Phone Number G -) GV ti
Email (r! C 1 . C am
Address2-11U. W WS
City s
State W p,
Zip
Propert�, Information
Project Name
3 W 5114���T p . , MII W T IF
Address 4J
6 v N
City fV
OAO ✓ a
state VA
zip $ O
Parcel No.
27 0S23 00 10 (100
Does the property currently have water service? Yes (City of Edmonds water) o No
Proposed Development
Describe project (number of buildings, number of units, number of stories per building):
Q►az-litJ►-' �1wlcsl,E� �AcMtLY }�OME -1 rt�JU-S'i"O'Q`i '4S'000 ST
In what phase is the project?
❑ Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: _D'JZ.C.202.R - 000rj
SECTION B
Exemptions from Utility Availability Study: " Single-faa.:uy residence j 1Viulti-.a...ily project of four
units or less with combo water/fire lines; 3) Sho p a vision" four our,
lots or less). Please
check onVIA
the following:
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�-BuildingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through ,vww.M�-BuildingPermit.com.
APPLICANT SIGNATURE: DATE: a7'A31/2
APPLICANT PRINTED NAME: E2.(K 44. L-um
Form Updated 3/28/2023