ENG2024-0572_Utility_Application_12.26.2024_3.36.17_PM_4687281RECEIVED
DEC 27 2024
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SECTION A
SEWER AVAILABILITY APPLICATION CITY S EPARTMDMONDS
DEVELOPMENT
SERVICES DEPARTMENT
Complete and submit this form through Nvw,v.MvBuildinaPermit.com. Submit as a
new application using the following prompts: Application Type — Utilities, Activity
Type — Utility Availability, Scope of Work — Sanitary Sewer Main.
InformationApplicant
Contact/Applicant Name
Phone Number _
Email
Lq'
Address u,) ( G , L E - C4-�-0 A-uE 1
City lV v l ue f
I State A-
I zip Z
Property Information
Project Name b r��
Address
City E�PML5� t
State
zip
Parcel No. o.v D ,o-�7—^
Does the property currently have sewer senrice? o Yes (City of Edmonds sewer) XNo
Proposed Development
Describe proje (number of buildings, number of units, number of s ties per building):
In what phase is the project?
❑ Design Review XBuilding Permit
❑ Preliminary Plat ❑ Rezone or Other �"
Associated permit application number(s), if applicable: Li7� �c���% C—�l(P NUT P-,UL(,T)
SECTION B
units or less; 3) Short
vailability Study: 1) Single-family residence; 2) Multi -family project of four
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 i"%,w.MyBuildingPermit.com.
❑ A utility availability study IS requested/required for the project, and associated fees will be
due. Please submit the complete annlication through
APPLICANT SIGNATURE:
APPLICANT PRINTED NAME:
DATE: 2
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Form Updated 3/28/2023