ENG2024-0573_Utility_Application_12.26.2024_3.32.18_PM_4687265RECEIVED
DEC 27 2024
of EDLIODV'�
INC. 1 g90
SECTION A
EDMONDS
WATER AVAILABILITY APPLICATION CITYDEVOELOPMENT
SERVICES DEPARTMENT
Complete and submit this form through ,v-Arw.MN'BuildingPermit.com. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Water Main.
Contact/Applicant NameG�
Phone Number
Email LV rl i el t
Addres n { h � t C k�' LS _ Y tpo
City utc't ^'
State
Zip rj Z
Property Mforniation
Project Name Gi
Address G
City VU(Ljp�CA 6RO
State
Zip
Parcel No.
Does the property currently have water ser%rice? ❑ Yes (City of Edmonds water) >(No `ofW (W t 13 F-Ouf
IProposed De,,-elopment
Describe project (number of buildings, number of units number f stories pe building
!4 LAp �lZ 6� V� �Z 5'T1��5f 5wtT
In what phase is the project?
❑ Design Review Building Permit
❑ Preliminary Plat
❑ Rezone or Other
Associated permit application number(s), if applicable: LO 2D 1600g�96
SECTION B
Exemptions from Utility Availability Study: i) Single-family residence; 2) Multi -family project of four
units or less with combo water/fire lines; 3) Short plat subdivision (four single-family lots or less). Please
check one of the following:
VA 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 wr«4.M�,BuildingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the
APPLICANT SIGNA
APPLICANT PRINTED N
Form Updated 3/28/2023