ENG2023-0174+Utility_Application+3.28.2023_4.30.29_PM+3449383DocuSign Envelope ID: EDA8A7B7-3B3A-4AF9-A2A5-7F013636A5E0
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SEWER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
SECTION A
Applicant Information
Contact/Applicant Name HBRE INVESTMENTS
Phone Number
206.380.9989
Email
AUGIEBUKO@GMAIL.COM
Address
1951 3RD AVENUE W
City
SEATTLE
State WA
Zip 98119
Property•
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 sewer service? D4 Yes (City of Edmonds sewer) ❑ No
Describe project (number of buildings, number of units, number of stories per building):
(4) TOWNHOUSES, EACH CONTAINING (3) STORIES
In what phase is the project?
❑ Design Review
❑ Preliminary Plat
® Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable: BLD2022-1328, PLN2021-0074
SECTION B
® Applicant certifies that this project is a single-family residence, multi -family project of four units or
less, 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.
❑ 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.
rQ '0d by u 3/28/2023
APPLICANT SIGNATURE: I �s„s® 6ulows DATE:
APPLICANT PRINTED NAME:
Augustus Bukowski
Form Updated 12/9/2021