ENG2023-0138+Utility_Application+3.15.2023_4.25.09_PM+3423800of EDA10+
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SECTION A
WATER AVAILABILITY APPLICATION
Complete and submit this form through www.MyBuildingPermit.com.
Applicant
Contact/Applicant Name Alexandra Immel Residential Design LLC
Phone Number 206-501-3038
Email info alexandraimmeldesi n.com
Address 3439 NW 62nd. St
city Seattle
state WA
zip 98107
Property Information Haider Residence
Associated Permit Number BLD2022-1324
Address 915 Brookmere St
city Edmonds
state WA
zip 98020
Parcel No. 00548900000302
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):
Proposed 2-story addition to (E) single family residence. 1 building, 1 unity
In what phase is the project?
[A Design Review
❑ Preliminary Plat
❑ Building Permit
❑ Rezone or Other
Associated permit application number(s), if applicable:
SECTION B
BLD2022-1324
131 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.
M 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.
Applicant requested paid certificate.
APPLICANT SIGNATURE: �'""' �"�" �" ArR�' DATE: 2.8.2023
APPLICANT PRINTED NAME: Jessica Kashian for AIRD
Form Updated 12/9/2021