ENG2023-0173+Utility_Application+8.17.2023_12.14.49_PM+3731999DocuSign Envelope ID: 936FA480-7879-4443-852A-4A829E75B2A9
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WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
INC. i S'�.)
SECTION A
Applicant Information
Contact/Applicant Name Interurban Investment Group, LLC
Phone Number
206.380.9989
Email
Augustus.Bukowski@cardinalfinancial.com
Address
222 3rd Ave S
City
Edmonds
State WA
Zip 98020
Property Information
Project Name 310 DALEY TOWNHOUSES
Associated Permit Number BLD2022-1329, BLD2022-1325, BLD2022-1326, BLD2022-1327
Address 310 DALEY STREET
City EDMONDS
State WA
Zip 98020
Parcel No. 004342-026-001-01
Does the property currently have water service? X Yes (City of Edmonds water) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
FOUR THREE-STORY TOWNHOUSES, EACH CONTAINING ONE DWELLING UNIT.
In what phase is the project?
❑ Design Review N Building Permit
❑ Preliminary Plat ❑ Rezone or Other
Associated permit application number(s), if applicable: ENG2023-0173, BLD2022-1328, PLN2021-0074
SECTION B
❑ Applicant certifies that this project is a single-family residence, multi -family project of four units or
less with combo water/fire lines, or short plat subdivision (four single-family lots or less), in which case
completion of a full utility availability study shall not be required. Please sign below and submit this form
through www.MyBuildingPermit.com.
N For all other permit types, a utility availability study is required and associated fees will be due. Please
submit the complete application through www.MyBuildingPermit.com.
DocuSigned by:
APPLICANT SIGNATURE: 59*sh�'s 6WSLI DATE: 8/15/2023
76AAFCE37431496_.
APPLICANT PRINTED NAME: Augustus Bukowski
Form Updated 12/9/2021