ENG2024-0051+Utility_Application+2.1.2024_12.39.11_PM+4034588ofE�'n
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.
SECTION A
InformationApplicant Contact/Applicant NameS7-1 k uM -'f LEA- eNCrL.s EJG 1TG'G'f5.
Phone Number V r Li
Email C ► P/M" . GOB
Address Q
'IV
State vi >C
zip C) ti2,i
Property Information
Project Name Lf0 N 0 'iCV73 — �.i 1,-.1 Ftr�fl AiGly
Address 101.40 '5V "i; —r V v' t
City to
State �
Zip
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):
In what phase is the project?
❑ Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: D1ZC9_QEL1 — 000 5
SECTION B
Applicability
Exemptions trom Utility Availability Study: 1) SiMje-family residenc • 2) Multi -family project of four
units or less; 3) Short plat subdivision (four single-family ots 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}.-BuildingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through �,ww-Al BuildingPermit.com.
APPLICANT SIGNATURE: L% ' DATE: Q 01
APPLICANT PRINTED NAME: SQ IK. �t, LUMP
Form Updated 3/28/2023