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SECTION A
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildin&Permit.com. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Water Main.
Applicant Information
Contact/Applicant Name 'E9.1K Ti��. �L ii'CCTs
1
Phone Number G 6�.( ti
Email (r! C 1
Address 1 ��
City ise
State W
Zip
gilst
Propert�, Information
Project Name 3W 5114���T Ml�'W TIF E „
Address 4J 6 v N
City N
State VA
Zip $ O
Parcel No. 27 0S'Z5 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):
OkM— 01J►T' :GsQCsI.E—VAcMtLY �WME , —r\,JO— S'i"O' s . -- S,000 Sf
In what phase is the project?
❑ Design Review ❑ Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: _ p'J�,C.202.4 — (300rj
SECTION B
Exemptions from Utility Availability Study:kQ Single-family residencD2) Multi -family project of four
units or less with combo water/fire lines; 3) S o p a vision our single-family 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 www.M}-Buildin-ePermit.com.
APPLICANT SIGNATURE: DATE: Q7'/0 (>/
APPLICANT PRINTED NAME: E2.(K 44. Lc1N9
Form Updated 3/28/2023