HomeMy WebLinkAbout20251017_PLN1415_Utility Availability WATER AND SEWER AVAILABILITY REQUEST
Community and Economic Development
City of Arlington• 18204 59th Avenue NE •Arlington,WA 98223 • Phone(360) 403-3551
Submittal Requirements:
1 Complete Application
2. 8-1/2"x 11" Site Plan/Sketch of the Proposal
Type of Request: ❑ Water Only ❑ Sewer Only ❑✓ Water and Sewer
Location/Legal Property Address: NW corner of Medical Center Drive and 212th Street NE
Lot#: Parcel lDNo(s): 3105120020040013105120020700 Subdivision:
Project Scope of work: Development and Construction of a Medical Office Building
Owner Name: Public Hospital District#3 Snohomish County Office No.:
Email Address: Cell No.:
Mailing Address: 3405 173rd Place NE city: Arlington State: WA zip:98223
Owners Agent: VWA Arlington MOB LLC Office No.: 216-464-5550
Email Address: sjurisch@visconsi.com Cell No.: 216-385-5420
Mailing Address: 30050 Chagrin Blvd #36(Cit : Pepper Pike State: OH zip:44124
RESIDENTIAL INFORMATION
❑ Proposed Single Family Residence ❑ Existing Single Family Residence ❑Accessory Dwelling Unit
❑ Proposed Multi-Family Residence: #of Units #of Buildings ❑ Residential Plat: #of Lots
COMMERCIAL INFORMATION
❑✓ Binding Site Plan/Plat: #of Lots 2 #of Phases 2 #of Buildings 1 Total Square Footage 30,000
TYPE OF COMMERCIAL USE
❑ Hotel/Motel ❑ Food Service ❑✓ Medical/Dental ❑ Office ❑ Retail
❑Vehicle Service ❑Warehouse/Storage ❑ Industrial ElOther(specify):
loll
Commercial Water Usage: Monthly Estimation: MM 0 Gallons
WATER,SEPTIC SYSTEM AND FIRE
Is there an existing Well on the property? ❑Yes ❑✓ No Is there an existing Septic System on-site? ❑Yes ❑✓ No
Water Meter Size Requested? 0 5/8" ❑ 1" ❑ 1.5" ❑✓ 2" ❑ 3" ❑4" ❑6"
Type of Fire Protection Requested? 0 Fire Sprinkler System ❑ Fire Hydrant ❑ Unknown
I, the undersigned, request City ofArlington Utilities Division to certify willingness to provide water and/or sewer as indicated.
The above information is complete and accurate to the best of my knowledge. I understand that any changes to the above
information must be reported immediately to the City ofArlington Utilities Division as a condition of Utility Availability approval.
Shawn Jurisch Digitally signed by Shawn Jurisch Shawn Jurisch 9/22/25
_.Date:2025.09.22 13:58:04-04'00'
Signature(owner/agent) Print Name Date
Pagel of 2 REV02.2022
TO BE COMPLETED BY THE CITY OF ARLINGTON
CITY OF ARLINGTON UTILITIES DIVISION - PRELIMINARY INFORMATION I CERTIFICATION
This non-binding preliminary commitment is only valid for the above referenced property in accordance
with City of Arlington policies and for only 18 months.
YES A water main or other capital facility improvement ® is required; ❑ is not required
(If required, refer to below conditions)
Water is presently available from City of Arlington to service the above-mentioned property and
YES specified number of connections per the below conditions and upon payment of applicable
connection fees and charges.
Fire Flow Estimate: STATIC PRESSURE 68 PSI RESIDUAL PRESSURE 41 PSI FLOW 4.430 GPM
NO A sanitary sewer main or other capital facility improvement ❑ is required; ® is not required
(If required, refer to attached conditions)
Sanitary sewer is presently available from City of Arlington to service the above referenced
YES property and specified number of connections per the below conditions and upon payment of
applicable connection fees and charges.
Other: Water and sewer service is available at this location per the below conditions.
Approved By: Date: 1011 ? ,ZO2
EXPIRES 18 MONT S FROM DATE OF ISSUE
COMMENTS:
1. Water service is available for this application; a water extension is needed from medical Center
Drive to Stillaguamish Ave. Please coordinate with the Arlington City Engineer for water service
line connection, meter location, backflow protection, utility easements, on-site water main
alignment, and any other water supply requirements.
2. Sewer service is available for this project; please coordinate with the Arlington City Engineer for
specifics pertaining to off-site sewer connection point, service location, utility easements,
required pipe slope, monitoring manhole location (if needed), pretreatment requirements, and
any other City of Arlington sewer requirements.
3. Any wells and septic systems on the development property are to be abandoned per Arlington
Municipal Codes 13.04.140 and 13.08.160 as a condition of service.
4. Water and Sewer system improvements shall be designed and constructed in accordance with
City of Arlington Design and Construction Standards.
5. Fire flow data is from water main at intersection of Tveit Rd and Medical Center Drive.