98-100333 Ul
O CO II �� 11 0 0 0 CD
n II
II
O Q. fl 11 11 O O on CO 7i
• r1 1 fl 11
II n �; m II
II II• it t`- N It
Q A �� n it 11 II
—1 ti V tT II
II 1i v►h3 En l
II
(T) M U- O i ii ii ii
CIO G fi H n +< it
R LW II a
.. �!H.
II• ii �•-
} (� ti fl M II 11 =
Z (-i >� Li ii n « H li
ii it N 11 Lw H c1 11 W
(ljy It It w O it i70
it it N 11 W s CC tt
�-- i--( II li �O 11 w ¢ 1 J
Fi CO Q
It
it • 11 • Cl. s II J
H
1� X ii II H W = =CC
II =
}--i �} II fl 11 11 V z cn c.n II• N
II
i IU If H H z Q V W it DIC
C. II it CC II ¢ H V w 11 W
It n CC it -� O CO II
11 u ii •• a PQ co J W
H
it
H 11 H ii w O li Ca
II II n c.a_ .-- n O'
II II H it W
n If It II CC
11 ti > n Ii •II it F...,,..e.._..«...�......_.....».»,.......»._..,.. W....,....._.........qp....... «..............._..... ,.....«„ �... _.,-.«,..,..•iI W Y
i{ n n n V
j o II II •..t i a II n ¢ DC
.� ii 6 it rn ii 't O J
CC it y2 !t it ti N Q
LO it A it c, ° c-- it O O CD CD O CD O n Cl) W
•t A it W II P• P• P• •• it 11 A
1 W it W a,n •• •. • C"• If •• II L CO
•� J t{ 11 • •• cn H • • co • n O W.
it Li !I ¢ n 1- • CC CO It
tl O n - W W co II C= • w co II W Li
n it if N • V V cC H = Cl) J OC H 1^ O
!ice^.,.-•..._„. ..-. ,..-.•.. tl Y it C (JO • H H ¢ H O Lo Y O i!
II it I••• it C!) ¢ ' >• H W W z F— H 21
_ } 11 11 �••. II CC J 3 CC 0: W t Y .•-� X it
11 V 11 GO co O_ co w �_ ti _ co ¢_ CC H It CC .•°�
co
II n W II Y A W co t.!) .— it J H am
�^ [n Cn w II• I- v
' � �� ti CC it z CC C �+ it ¢ Y on CO Z [C tl W W
11 �•• ii H ¢_ co w W co it Z 2 d H z W it CC J
I tl H = it a ¢ Cr w W ii s []C = ¢ ¢ r-
un Il CC CC
II 11 II
0 II CM
II tt 4._I II
on s W 3 co {{ O A on C> A J O 11 CC V
{II z= in 11 it• i ti r-- '+- `F-
IA 11 11 W G3.
11 II I1 tt Z Q
- QJ �� II N li O 0 0 0 O 'i 0 CD 0 0 0 0 0 0 II O
11 CL
> 11 n n O O O {{ it W
II V_ 'I II ti W S W
'4_ it it 1"2 II c- O O O II .• .• •. ' H• 1� ¢
r-1.= (� it 'i O ti •• II 11 CL A A
II
III OC 11 it 11 K Z
�� II C3. II CO Y 11 co on H W 6
i{ Il II Z V •• it CC .- fl
11 it OC II .--. ¢ co II W J t{ N �+.i
II II O 11 Y
PO V 11 f.!) 1- F- II i�
II
CC
? F E II It 11 ¢ w w• If W CC w O it• = W
CIO CC =7
-x=•r-f fl it K 11 A cf) CL' Ii Co N Co S 11 CC -�
It CC 11 z = `i O N W s ii W =C.• �) H It H 11 ¢ A A c17 71 J A H [ . [K • II CC O
It it _-1 W W 1- 11 V = co [C ¢ /--- CO II 3
(� 11 1 N it G?. cc CC Z W [C • ii 1-- CC O 3 3 3 If CO 24
H W 11 O A ¢ CC 11 W f- CO 11 =
_ 11 m It J n a = = O_ H w W fl co S 3 CC Y s co Z H 1-.1 T
' ' �. tl z N II CC 7t S_ O' O' L� N CC c. H h- H CD z --. W = Il A C
_ ii O p 1i CO II CD w w S 11 ¢ ¢ S ¢ .--1 J ¢ n CC
n H co 11 ii V ce C .-.. ii 3 tCCI co J cn A W _J 1! CC LL
i CD li H 11 CO O
CI V d O� n = It•...,....s....»:-,.e�_..,...._........» ...•.....,......,....... .iF....._.�..�......t.�.. ....- ..».-x•11
}"•'I n = ¢ n 1••r ii II t{ A I�
II CC s 3 11 f� n -.-+ If 11 Z N
11 OC H v-- t {I 6 W
ii .- i- GO CO tt O I1 it on ii O
C' co r• CC NO 4/i H CL II 0 CD 0 CD 0 W n cC 0 CD 0 0 CD cn cn H J
P-1 i- CC z .--1 ¢ CO V'1 11 W 11 O O Ch it O it 6 W
_ O O CO 3 �O �t 6t OC II O '^�� 11 CO it ►•t _
✓ V 3 J 1 a 71 n •• CD u”) m it N •• •• •• •• it t•- H
ri . II = it N O it W A • 0 .7•
¢ CC co ¢ GO V it W (t H C it CC 3 A H W O
O! W CC VO w H oc H H N it CL = z ii A t-
• ^, 1---
J r-1 w f J H 3 H = O ff 2 • • 2 = • CD O n H
_4";-1 z J r-. A
CD Cr) W m J II
!) H I N it = •+ it Z O O • co K O l N
II V z Q 4-- 1--- Z Y CD cc n W V
✓ CC v W N 2= it CM 71 CD O •Efi CO n �-O .-- O C7! CO ii cc W
!1 11 ^ H z on H w li [.n 1--• O CD .-- CC w cc 11 CC
H H ',I it H w 1- 1- • • ? it Cr .r) co Cr) .--- > W n CC
11~••�-J Rp it J H x ¢ 1- • 1-+ ti co oo r-1 1 1 + CD CO 11 • O
II II W 11 J CC CD = Co a W tl ..--. r . i.n CD CD J PO z n A V
II ti A II W O H J I-3 6 V II .-4 CD CO .-1 m ul W ¢ = it W
11 ti O fl 3 W tt O = 11 1- A
{I fl V ii A rr s s w a [C II CO W H CC =
H 11 II H II Q CC
II I II O it ffl II N W
.••
II Ii 1 If tl H CD
II fi r- H v-- •- w- V- •.- v- •.- •.-- n n Cl) CC
H H .CC n V) V) VI U) CO V) U) U) ii tl H 14.
z ii 11 V II . •• •• c'::: • •• •- 11 H
O II it O II 1 0 0 0 0 0 4 0 it CD O CD CD CD CD c.c) d ° it �t N
II If J it . ti /- H CC FM
~ tt H W ii O
II it •• •• •• z 11 =
H it N II .= it = CC CE H
A H 0 = H a H o_ LG. H O
CO it tl 1! . +• •• •• •• It GP V V 11 DC
¢ it W 71 I CD CD 0 CD 0 0 0 0 it • LU z It lii
F- w 11 11 N II �- !i W H CD CD 11 L.L.
LO c9 it 11 CC fl CA it Y 3 Y J O O {I I•-1 A
¢ 11 ti W ii H II C O O A O CD i{ CO
CC n n J H X II O 1--- O 2 .. it W S
r (}„) _ ¢ 'i fl Cc If co tl 3 LO r1 ¢ O CD li V N
CD n•P 0 F— .. It 11 . ti i • •• • OC' t- oc • J H co A H- A z V s .--i H II CC 2C•
11 N n CC .- A A S S V CC f»- H z O V CD CC CO CC it =
}_ G �- Z 1f 11 CC n J co z O! .- N LU ¢ O H ¢ O = O = H tl N
II O� 11 w H N M O CO if iI G MM W-
c 0 03 Q G )
~ II II CC !I it !1• Cu co
F— It 1{ F� II it
II 1--- 1--
Q 03 EO ("7 H n H O •• w c» 1 H it ¢ _
H V u c n n m
II m 11 tr 7C -. • fi 11 N O
O4' a
CV H w H Jw n• zc• a .� n YLV
IA
II O II M it a CO •• O •• •• it c�• •.- II
CO 11 H a
) - aOG � G0? 11 CO~ °' n M n = •-- ° II II .r
n fl A V I[ O 71 O W t
L t� O �i Ntt! n ¢ H H r• A > a = it o00 aoo ° II cos
II S 3C
II ti •• •• CC = C•.• a C• if H .-1 t-
tL 3 �7 ri L�1 c, ❑ .— .° u n c • .• 0 .. .- .. A .- H r• I Wt- 1-
If CD ¢ CO ii it W CC W CD C= O it • CC 11 CC CC z
(,t_ },j_ r-{ Y..1 (,f'� )-.{ �-. 1 CO 3 r-1 11 II CE O .- O J H CO C•J • • W it H = W
• it it 3 4C a-
c, V 11 co z Y Or CC • II d CD
co G �C �B 14 ttl I ii .A� a J cr.
u H U v_ cam• c • 1- n a .. CD w cn t x ¢
CC O [C C%] II• 11 X CD co ¢ •• O ¢ CD it 1-- H CD 3 PO o CD II W W CC
J } (�' !^' z z CD A m n c-LU 4_fl w II J Cs- � � - A c, II co- ••a-
CD
F— i� '0 co (-■- 0 a o .* w v� a it A a a co o u n W co s CO z a CO a Co cn n ►- CC cc
I-4 M Q.) In 4 G O CC .-i ti N II I J 9- W V c`• 7- c'• V 1 ¢ _ ¢ O 2 ¢ ¢ ¢ II z W W
11 1l m ►- Co O •• 1- •• O C9 L..G C•1 V PO Co CY CD H CC V z
_.. :; CO G_ N <C Z CL L... n c -r o
7'...
,....:
...... _ .......______
4 F P • . ................
1
--..: il ".
...,. „...,„ 41 il it 24 .::::: •
,..... 4. ...
+.. • „
Coe°
..-..- . .... -
., ..-•
• . ''.....s......:44%••■,.:. c><"
••••••, •
,t ... .
,..,...■
4444 !!
CL ,
7 , =
st 7
.. •. __ . --, s7,4
:3 .,4•4".. CC ' liC
:: ,..... 4..*
...., . .
...... -...i C7
. ....4. ..
ad
• =
_. g■ •
' g ,,* r ■■ ■■ ■.■■a........■ .......■••■■■■■••,■•••■•7: 1...., ....
,..„ .
: .. .
r-4 ,
Z •,, -_, ,.• 6 C0 CC. C:, C0 C:, C0 C0 1 ‘r,', g ' '
ti ••••• ag
, •77-? E S. , 4 lii
OC 44
...,., . 4,
'il tt
. - -,..fl• • •
: ... -. •
_ .. . . -..,
.
. 664 4.4 a C2• l.__4 l.__4 d M 6a.l 1
ARI A
• '- - • - .. t . g. -. . - -....--- , . r
- -. ,- -- ., ,= .5 4 i.. .
•
, . ■4 C. ........, JC Q.. CC ..4,1 A • ,,,,,, ■,..4 ,4'. X 0...
• -- ... LA/ S.,,„ - • LA. a., P -* g e Ca
•
Eel ca.', ••••• ,4411 = 1..4 0- Lt.
-_ 4 0+
1.-,- ''" 4" "". c:.. oc t: 4 7"C' -77' , 26 12 '' .t,
t..... •
. - ,-.. .-1: ..,. -,.. -., ,:t mic ac Ci .. 2C Ya
I.- -, ..„ .- 2W 2C ” .. .. 2C --, GC DIA CC
--
-. 7;7; dis-4 4 tg t".; fill 2§ 2E 5.; ;! 2E f..5 .Z7, • '4 !! •...
..., -- ...., ....- ,
a ...
q '..,,' r. 4 •= ,•=3„ -4:1•, 7n I Ca C75 C7 = ..In = CP CD
4 100 **** 0....-
i i :3
;,a • , • • • ii Ilma
- ,
14
..,_ ,...., a.,..
un on a se gg
4 aa mg
i• = 4. 6...•
CC . Ufa __4,. ac .-
......1 ti
u
4 401 ri >•
5.-.*.
IL
C- ii
r'
-4-.'4..
.C-g. 0 4 ta.,
m..c.1 -.••..-
c-
- ■ f4. ■ • - ,-
1C
c0
- - q , • ., . $ >: ._ . 411 on ,. 7 E k. ,- . = c, v.' -' ..).
g. ■,' It I 0
,- ....,..., at: ccc a =,
c., .-•I a e . 34/C t, cZ 4- 1.. ., + 44 6-, Cl C . md.r 4loin
a - :.. .... 1.., if . ,
of -- 4 t
n -I
-- 0- z....:- 7= ,s,.: 24 * CC ...., a. 4...• g M -
4 , , '..." "7: "....t......4 :: fa t sic cr". '4 . .7.,•• 47,., . ..i wa i 4-414 _ .-= a=. = . 0 ii.i :0C.
- . r... 3- ,.._ .1, c. i. , - - , 41) '14-4 4 ,5 5=
LL
3 ‹C a. ".** -.4 mc 4
ai. ,-„'. ' ,•••• Oi 0 k 114 § 1115
:: ...• ...... (T. 41...."...m.......x...................................11
.__
V a..1. 0 *00 4 d121 i...
I Iiii. a ..._, 21
,, _ "."--
40C DC DC n
....- ‹c &
. -- .- ,. ..,, I! P . .
., - urn ,...- n- ,....n CC• , r '.'.. 47- C• , 3 -=', X. ' CC C7 CD CD CD CO . CD CD .4
igm** - Cg =•• 44■1 CZ C4 ill iielkii ii 4:.;,. .'''' <7 CC xti
. . co cc, r, mc -..c. ,a- :a •:- 44-ib - ....-, •
.- -.• on, r:
4 r-1•,.Z-..-.=....
li .
="
' . CC• cir:1 d
CI4C*nI11P C.
• . - ., 4-La .,, — i 4 — - . --, ' , - * c., ad
L, r . y 0 1 .. '; - --•S 7 0 4.4.414.. - . 3 i C s.. C:
4 • — -• "--- ' ' F: tii C - ■s- 41
" = — - 7 . ..r rn ..-i. a ..- C
• 1 1 t 1 *2 *-'
-4 ' • 4., CD CD .14 ai 2C , Mg -...,
.-s =• 1! 9.... lia
**- ;', '1 it-' i, 07-
a tel t
,,,,,,,, • e it
. , ..... . 4..- 4-- 4.- 44.- - sq.. 4.---1# ii
II CC ,. VC VI /di -4 ,4-4)4=" !! .0 W.... i
i..,
.,-4'4 „: -* , c3. cD = I:, ,gp,.•..-At. 4z. i CD :D CD cr a CD ye> CD CO 4 id at i
-. ....
, -p .., 1,
Cz . . , I Itt. • - • • —, 43. IC N ---,
„.= „ , 6iii: ,$ ii3i, 444 .3 i,,Ct* .040. •:::, 4:o, :. ,, ,
0-- ,..,,, 4 • 4,, • ....4 '....- '..... g No '-
,A.., . 4•■■■ .3 ••,..., r. indo. „z, . ,
= 1 ■
•.,•.) 7.„; - , ,. , . . . ,i, ', , ot -Y id • ..d 4 6e, =a 0.- 42 CC 6. ',
ta 40',
....... „
rn.„, ,__ ii, = C '444, 4 A CC
•- ”
• : - - 1 . -- :.7 - -t4-4 44 aS C D - - a
,, ., . ii ii .i, • .
,.... = ,.., 2c L.- td-
C
'.."-: - 4
,
:C ..:.^ 7-• -, 1 4 '-.) 4
-- : , .... ,,, n .4 ...., ......
g imo 0...
..4.,- ,:•",.(I: --,,. - 7., a
....z.„ _ .„,„,„ co
',. 1. a 1 --• 4 g g 4 '::. f2 A :
• 4... _. Ca '
•
.
...• ......„ - '....., „,. 4 C*, 4 4 = •• • 4 i,
Or 4 .....1 a-4, 1, 4., t t2
C-41 a
..., .... C:, ., 4* 4 C,
CO .1 o ,
. ,......
S 31 .....,..
IS ...„, . _ , . .....„ CC , 3 ,- C. 4,- O. 14 4 C.:,
77 C7 C' C. CC C. MC '. 45 IN 4
• . ,
q. 4 •• c- cc. c.
'
44 ,.., 5' - ,. ,r D- en :. 6... Y4 ,..0 G. -.14, GC = ' •• •• •' ••• •• • •• • •• 4▪ NI t: ;;
to .= co , , 4.-L li „ GP ac C. • : g - a ,.,
• - -.... r- •. T-7. 7- ii ,,,„ ..'" ....,. . 1 ac t...- C' ....J 9 CA G./ 4 • ■•‘, •
• ' 'it 1,.. ‘C
.
it .-= 4344 ,......, ii L..; = sa. • 3IC CC
it \P . ....-. .... ii 444.1 3IC - Cr, . 4 4-, r- e. -^ 0 C, .. C. • ad ua CO g id cC •
---1 .1.... ...„: • rt `-'" <c• 522 ' 4 ,,.._ •• ,_ -., s •• 4 - cp... ,:::, 0- 5g Pa t I oW
..,, CC .3 _ e-, p .- .■ .. cc
-.>" 71 c'77 - _ 77.'
7.= = -.477 C. en -
4 ft •• = co. Co
o S. o...., ...n :P 14., =3 a cy ...-. Cc
:T -5 CC C. 2t ,.., -... 4 4" •=7:, cr.,
40 in■ .■
..- .:-.. 7,.. -77: -- • 7:: =sr cc -., o.., •_., • ca co = %,.... c-
II ts.Effr-ti• . :;. ... ....----,--.......•....i.,:• •,-
............ .. O, ..
. on ..... 1., cc i! on srl m
s .. D- .. .: r- › .. A = 1 ,C3 CL CC. crc r
' 3
C. ‹ - - . - . 4
...--------...............---.....,
-..., „...7,.
, .
(LB/4 Aa )E6L000
•
Ag alga
uZ
� -
A17-4
— era
s A.
'f�lld Ia 1f18 61.
.................................................................................................
.................................................................................................
_.........�tg..... .... ............. ......... ..else
.................................................................................................
.................................................................................................
'1t/PII� al 8l
(—Th'i 7....._Ash-�' � ...` 7......:� 0
L
................................................................................................
.................................................................................................
dg eiea
.................................................................................................
................................................................................................
Ae eiga
i(g eiea
? 4 C
pi.
A9 alga
El
ii9 ergo
As 'z eiea
.................................................................................................
.................................................................................................
Ag elea
0 I.
ice else
gNldld 6
Ag glee
8
eiea
L
oleo
JN1�II� Cf! #1 (l1�11 9
c9 elea
.............................................................. .................................
1l11Q> IGdSNMBQlN13OC S
ice elea
b
�(g elea
................................................................................................
�1a1�1tE1NFffiS:<OWIIIIE!'ld E
Ag erea
.................................................................................................
.................................................................................................
1
BUILDING DIVISION
OF
RE W�/ ;;
33530 First Way South
Federal Way,WA 98003
FEB 0 3 1999 (253)661-4000
Fax(253)661-4129
L1I WAY
BUILDINGYDEPT
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # - 434- D`` "7
Address ln. .
1
c
Tenant(if known) (7 e e Lot# ssessor's Tax#
? S-!53 0-039(0-C7Z
N\ Building Owner's Names 1� _} Address 141.4D tp-r■ S.-�
City F-Cd k-1 ( " 1 f (State kJ A _Zip g YG;-3 I Phone C39 -13 3 b
Nature of Work ( GV c cq e A-c1 d-+-1 D
�...........SAN'�` ::.,. . ::;;>;:.:;,;;,; :;»:.;: .�
Name (F,M,L)
Address
City State Zip
Contact Person Day Phone Other Phone Fax
Company Name !V\ix 1 ✓ (o S"t 1rl�C�'�(li'1J �.
Address 1 i-'� C — .1_ ` P L._�
City '.Q J 4S £.J 4 j' State "✓ 4 Zip 9 O of 3
Contact Person n 11 A�v__ Phone. Fax
Contractor's #(card mu-if-6a presented)) Expirati n Date Verified ❑ Yes ❑ No
Name Y\- 'A
Address
City
State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION ,,,,
Please Complete Reverse Side
i■
Østlng 6
[[
tt
Use -c{r Y P Proposed LA' ! � a t
r
K^
I Permit includes: \ Building ❑ Plumbing ❑ Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck
❑ Commercial ❑ Addition te--Garage ❑ Shed ❑ Other
- Enter 1st Floor sq ft 2nd Floor sq ft nr ' sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft sq ft Proposed Total Area lv sq ft
Water Availability 1P Sewer Availability ❑ On-Site Septic System Availability l S tL) _
Zoning I Lot Size (ci/3 `'Y U C'4-2 Existing Bldg Valuation $ gIIIIPIIIIID
1,tL.,oa
: E<>:<:
• Name Se, l c Address
City State I Zip
IM. OtiiiiiiiiiiiibifiligiakiiiiIiiiiiiii
Contractor Name Address
City State Zip
Contact Phone F:
License # _Expiration Date Verified ❑ Yes ❑ No
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
II1.. M8I Gs F.NTUt P:OUNT..
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total A xture Count
M>f
b`aVIAtiii1i.i: tti1 T.lii.li . MECHANICAL EVALUATION ONLY $
Fuel Type (electric/other) as Dryer Air Handling < = 10,000 CFM 15-30 Tons .
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Cony Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons '1'cita(:Und G4ttnt
DISCLAIMER:I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of
the above premises to perform the work for which permit application is made.I further agree to save harmless the City of Federal Way as to any claim(including costs,expenses,and
attorneys'fees incurred in investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,but only
where such claim arises out of the reliance of the ci ,' eluding its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
AaOLI—Owner/Agent: Date: — — ) Z
aVILDIMG.APP
REVISED 8/26/97
SEATTLE-KING COUNTY DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH SERVICW Activity Number ' :61-(00n-5
Total Fee: $125.00 0 175= 2Q -`
//�`� APPLICATION FOR HEALTH DEPARTMENT 1�
DAVE ZOR(SIt i APPROVAL OF BUILDING PERMIT
Submit application, route map, building permit plot plans, and other required documents in triplicate. The following
must be completed and the fee must accompany this application:
Note: If the property is located in unincorporated King County, make direct application to the King County Building
and Land Development Division (B.A.L.D.). Propertied in incorporated cities apply to local building
departments.
PROPERTY INFORMATION
House/structure is served by an on-site sewage (septic) system
Distance to the nearest public sewer V v\-1c_►�0 wtr-1
Address of property l LN D S.L? - 3 0 4 STT
Parcel Number (Tax Lot Account #) S 15 5,9-0-03 9Lo- 0 of
Applicant's name RAD"- ft 1212-[ Day Phone C53c'-1 $3 (o
Applicant's mailing address I s 3 04 '` S'r.
Owner's name 3 A-0'N- Day Phone
Age of House S 0 Number of existing bedrooms 3 Existing square footage of house 1300
Are additional bedrooms being constructed or created? -�
Description of proposed changes/remodeling (attach plot plans, showing existing structure, remodelin and
septic system):
A-Cicitik-0,-- 4-0 17av-cx-cf C C p
SEATTLE-Mu GGur TY HEALTH DEPT.
New square footage after construction SA-1 FAST DISTRICT SERVICE CENTER
SEWAGE SYSTEM INFORMATION DfsTE 'Z
Approximate dates septic tank was pumped (attached receipts) Uv.\
Additions or major landscape changes since house was constructed (examples: add family room, bedrooms,
garage, patio, deck, pool, etc.; major fills excavations done in landscaping):
Additions or repairs to sewage system (give date and describe briefly) (40-1-7 (AO Ikea k;A
r oa-r tN P/p� .�e>Ho�e� 22iz s - Replaced Pipe — RQtvi0,e 7r .�; 5�
Other information which would be helpful in evaluating the sewage system (ex. drainfield easements,
covenants, etc.):
WATER SUPPLY INFORMATION °)`
}� v,
Public system ( 2 or more connections) Private (well, spring, etc.) Attach copies of
well log , well covenants ,
chemical/bacteriological sample reports.
CZ)
FOR HEALTH DEPARTMENT USE ONLY
RP.-APPROVED 1'\A-O BY: ,,, ., RE E VED
DISAPPROVED BY: FEton A ived
Comments/Conditions: , . o• •_ 1
•
0-kr- 'ce,19.4r.rre_. -2L
EASTGATE
Any person aggrieved by any decision or final order of the Health Officer may a written application for appeal to
the King County Board of Sewage 1w if done so within 60 days of the at decision.
'V
I
--1
ri, ,4
-- _
y •.__,, -
- . ,•., • FEB 0 3 /988
I J. cii47.
- .
•
... ,
f34TTLE-KING COUNTY H.F__Ikt11-1 DEFT
•-: ,,,•:::,.. - EtiTER i i c47 • — •,..."
EAT D;SINCT• ci•. .,;
- v —
_.,...
__
_____
. _ _ _. _
Is-5
.......,__
,-,
...
. , _ 4___ _ _ _ • _.
• .
1 , ,
• -: ; i
I • v.)
.....
I..; . r . •
V 1
I f 6ras
•
' , -s-----...........,...._ 1..)
a , - J ''....,, -
-.... E __ _ _... . _
...
..... i .
4 a<I 7.1•%411'"'
.•-- 1.:1-14
#- A.),-,,,,,, -- / ''''-- - .
05, ,• — . '77"..-,-------. . ...,..., / )
.r• •
5)....... -- , . -
- • 4.1 -. •
--I • / ,.•-•,,, A...
-—
f C -1 .
"'/ ..1
4 "......
•..........7.7.. ''''''''''''''''''''''''''' - — --s-- i
....,
i .\••.-;*
-,,, ■C.1/4. 1C ............................ .S.- --i
■ '2.-- 7,..•................. NI
.....•
•
: •-'• '
...
..
1 _________. -_ •
...■ ....■ i
......■ -.... -.... ..... ....■. ...... ••■■• ......., ....■. ...... ..... •■•• ••••... ..■., ■.... .•■••
ICI
\•Af•
-— —...-- -_ . ............. .........-. TRIM.=
0 0