ENG2024-0495_Utility_Application_10.18.2024_9.37.34_AM_4567951of EDAg0NO�
SECTION A
WATER 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.
Applicant Information
Contact/Applicant Name JOSEPH TRACY
Phone Number 860-798-9521
Email JOE@FIELDREPORT.COM
Address 450 ALASKAN WAY SOUTH
City SEATTLE
stateWA
zip 98104
Property• •
Project Name DAYTON ST RESIDENCE
Address 620 DAYTON ST
City EDMONDS
state WA
zip 98020
Parcel No. 00434209600700
Does the property currently have water service? ■Yes (City of Edmonds water) ❑ No
Describel�ro'ect (number of buildin s, number of units, number of stories per building):
A 2 ST�RIY SINGLE FAMILYESIDENCE
In what phase is the project?
❑ Design Review 0 Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: CRA2024-0042
SECTION B
Exemptions from Utility Availabilit
units or less with combo water/fire
check one of the following:
RECEIVED
OCT 18 2024
CITY OF EDMONDS
DEVELOFIMENT
SERVICES DEPARTMENT
residence; 2) Multi -family project of four
7ision (four single-family lots or less). Please
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.
APPLICANT SIGNATURE. 2% � DATE: 10/18/24
APPLICANT PRINTED NAME: JOSEPH TRACY
Form Updated 3/28/2023