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SECTION A
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.
Applicant
Contact/Applicant Name Bob Bozorth
Phone Number (425)772-8207
Email PointOfVision@Hotmail.Com
Address 1628 46th Street SE
City Everett
State WA
Zip 98203
Property
NameBothell Manor LLC Adult Home
Address 1520 1 Oth Place N
City Edmonds
State WA
Zip 98020
Parcel No. 27031300409000
Does the property currently have sewer service? JC Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
2 Story SFR Adult Home
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
WK Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
27031300409000
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:
® 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.MyBuildingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete application through www.MyBuildingPermit.com.
Digitally signed by Bob Bozorth
Date: 2024.03.15 14:25:37
APPLICANT SIGNATURE: -07'00' DATE: 3/15/24
APPLICANT PRINTED NAME: Bob Bozorth
Form Updated 3/28/2023