ENG2024-0069+Utility_Application+2.17.2024_11.22.34_AM+4066623SEWER 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.
Q V 09PT"XT A
Contact/Applicant Name Richard A. Okimoto, Architect
Phone Number (425)697-0983
Email raoarch@outlook.com
Address 9924 225th Place SW
City Edmonds T State WA Zip 98Q20-5924
Pi-op()sed Development
Describe project (number of buildings, number of units, number of stories per building):
New single-family residence and attached garage; 3-story
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
El Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
Exemptions from Utility Availability Study: 1) Single-family residence; 2) Multi -family project of our
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 wvwv.MXBuildingPermit.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.
rtial 1 • DATE:
APPLICANT SIGNATURE.
APPLICANT PRINTED NAME: Richard A. Okimoto, Architect
Form Updated 3/28/2023