15-101986 40 Demolition
City &Eco.D Way F 1 LE
Permit #: 15-101986-00-D E
Community 8 Econ. ev.Services
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: FEDERAL WAY VETERANS CENTER
Project Address: 29400 PACIFIC IIWY S Parcel Number:
Project Description: Demolition of existing 1500 square foot single family residence
Owner Applicant Contractor
ROBIN CORAK FREEMAN BELL CONSTRUCTION AND DEV FREEMAN BELL CONSTRUCTION AND
MSC FEDERAL WAY VETERANS LLC LLC DEV LLC
1200 S 336TH ST 601 VALLEY AVE NE SUITE N FREEMBC917DL(3/16/17)
FEDERAL WAY WA 98003 PUYALLUP WA 98372 601 VALLEY AVE NE SUITE N
PUYALLUP WA 98372
Additional Permit Information
Demolition Valuation 7870.00
PERMIT EXPIRES Sunday, April 23, 2017
Permit Issued on Friday,April 24, 2015
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: djIJLA jpL.N,G Date: q-Z/-/S
0 THIS CARD IS TO MAIN ON-SITE
ern OF Construction In ection Record
Federal Way INSPECTION REQU TS: (253)835-3050
PERMIT#: 15-101986-00-DE Address: 29400 PACIFIC HWY S
Project: ROBIN CORAK FEDERAL WAY, WA 98003
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 Final-Building(4050)
Approved
Date
❑ Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
0
CITY OF
PERMIT!PPLICATION
Federal Way RECEIVED ��/ !o
3
PERMIT NUMBER ✓ _ t 0 l 9 F (57 4-: APR 2 4 2015
_ _ _ TARGET DATE
SITE ADDRESS
suiTQE FEDERAL ty5g
U S WAY
aR4v PAcifc f+i9h ulati So044, , r'ederal Wall WA 4800 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL
$ -7870.00 3 0 4 0 2 0 - 0 0 -7 'i
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL "DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT Federal Wetti V e+eravl s Ce,n+er
17ert.c 1ov. of. exis-P.Aj ►des i c evrl-‘a.l ;Citalai.Ac
PROJECT DESCRIPTION e Ap J
Detailed description of work to p✓ h^ Ct.+
Ok ^ I1A !55o 5F
be included on this permit only 1 J
NAME PRIMARY PHONE
PROPERTY OWNER lin t- Fec r t ( wad kre-Mrart5 Lt-C-, a 63-835- 7(o7
MAILING ADDRESS E-MAIL
I 200 SOV 441 33st`` rme waa)coMGasl-,neo
CITY STATE ZIP
feckrg( via (,Jfl 98 c03 -
NAME , PHoifE
S cc_ l p(+ccen-F I v md1.4 - - - - - —
MAILING Ann C E-MAIL _ -
CONTRACTOR — ,
CITY STATE ZIP FAX C
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# I
FREEYV (3C911131- 3 !La / 11 ,20-15-, 49. --OD-&..
NAME PRIMARY PHONE
FraewWar% eel CoKSIV%1C E Ord 1betau- -. ca53 -c9(.08- 39 1.5
APPLICANT MAILING ADDRESS E-MAIL
tint Vail e i Ave_ IJ E )u 4e N +v lcr. leder a -Fb t.-d , coir
CITYSTATE ZIP FRB
p,,„4.111. wA 98370 0153 -y(o(o-3353
NAME PRIMARY PHONE
PROJECT CONTACT 1111er Free- c953-ack.-3945
(The individual to receive and MAIL ADDRESS ` E-MAIL
respond to all correspondence CaD! Ua ll ey Ave /OE SV I♦e v' er-f Pbc-d•c
concerning this application) CITY STATE ZIP
Pul cl(Op WA 9837c A53-i!-(0(o-3353
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred in
the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: a _0 DATE LI-2g-!'S
PRINT NAME: -lei f'rvertAav,
Bulletin#100-January 1,2013 Page 1 of 3 k:\tiandouts\Permit Application
• •
COMMUNITY&ECONOMIC DEVELOPMENT DEPARTMENT
33325 8th Avenue South
Federal Way,WA 98003-6325
CITY OF ''', 253-835-2607;Fax 253-835-2609
Fed a ra I Way www.cityoffederalway.com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning
Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and
submittal of an environmental checklist may be required,which will extend the time period before a demolition permit can
be issued.
0 Prior to submitting a demolition permit,the following items(as applicable)must be signed by the respective
agency(see attached Demolition Permit Contact List).
NOTE TO APPLICANT: Utilities shall be disconnected and services performed, if applicable,prior to issuance of the demolition permit.All applicable
items below are to be signed and dated by the respective agency representatives.
1.ASB- T•` !.ATEME6.ELECTRICITY
(Copy! -pp form and a..; •s sury from Puget Sound Clean Air (Electricity to be shut off and_meter remove
.
Age, Prov f S
IV t (Puget Sound Energy)
' (Ci of Feder. Way Building 01.1)
2.GAS SUPPLY 7.FUEL STORAGE TANKS
(Gas to be shut off,meter re oved and final bill paid) (Above or below grade fuel tanks, have been pumped or removed
SES � under Fire Dep rtm t permit prior to any dismantle/excavation)
(Puget Sound Energy) rt/ / ' 12 7q f d
(South King Firs and R�scue)
3.SEPTIC SYSTEM 8.WATER-Public Source (Check applicable box)
(Tank to be removed or tank to be drained and filled) f.Meter to be removed and final utility bill paid PPt� 3o%0e10001
sp, --A , y�.� 1t Meter to remain and be protected ptQt. 3o.tclapoa$t
�{, `��� /Z,Z,c.a-.....J LA-14K l-t li=1J LI'TI u- T3- 1V-i2 c c -
(King County Environmental Services) (Water Supplier) f (�s
******OR******
4. SANITARY SEWER (Check applicable box) 9.WATER-Private Well(Check applicable box)
o Sewer line capped at property line o Private well filled and capped
o Existing sewer line to remain and be used by proposed new structure o Private well to be used for other poses
ev I A - Nrrr c_zo,�s�-� c� t /
(Lakehaven Utility District) (King Coun Environmental Services)
5.GARBAGE
(All household garbage dis Al off and final bili paid)
(Wast Management/Other Company)
❑Completed Construction Permit Application form
❑Provide the following fees: 1.Demolition Permit Fee Based on valuation.See table on pg 4 of the construction permit application.
2.Automation Fee $20.00
3.WA State Surcharge $4.50
Bulletin#122—February 14,2013 Page 1 of 1 k:\Handouts\Demolition Permit Requirements
• A,Ive.skc geeor+-
Tyler Freeman
From: Rick Hess [RickH@pscleanair.org]
Sent: Wednesday, April 22, 2015 1:14 PM
To: Tyler Freeman
Cc: Jessie Buchanan
Subject: FW: Notification Summary Request
Attachments: FWVC Demo Permit.pdf; PSCAA permit and clearance letter.pdf; notificationsummary.pdf
Mr. Freeman,
Only the City of Federal Way can determine if their requirements are satisfied. We inspect asbestos projects randomly
and they are unannounced. It's possible we may not inspect a project site.We only require that our regulations be
satisfied but I understand that other governmental entities want our asbestos requirement to be followed.This means
conducting AHERA asbestos surveys,submitting proper notifications,following work practice and disposal requirement
etc.
If you would like to call me,we can talk further.
Regards,
Rick Hess
Supervising Inspector
Puget Sound Clean Air Agency
1904 Third Avenue,Suite 105
Seattle,WA 98101
(206) 689-4029
rickh@pscleanair.org
pscteanair org
Puget Sound CleanAir Agency
From: Tyler Freeman [mailto:Tyler.Freeman@ fbc-d.com]
Sent: Wednesday, April 22, 2015 10:40 AM
To: Jessie Buchanan
Subject: RE: Notification Summary Request
Thank you for sending that over. My question is whether or not this will satisfy what Federal Way is looking for.
I've attached there demo permit application checklist which must be acknowledged by the respective agencies.
This is a new area for me so I'm looking to make sure we have all of our basis covered.
Also attached is KDS's report that the asbestos was removed.
Does PSCAA have any further action to take on this site?
Let me know when you get a chance.
Thank you for your help.
Tyler Freeman
Project/Office Manager
FREEMAN BELL CONSTRUCTION AND DEVELOPMENT, LLC.
P: (253) 268-3945
1
• •
F: (253)466-3353
C: (253)509-2322
www.fbc-d.com
From: Jessie Buchanan [mailto:JessieB@ pscleanair.orq]
Sent: Wednesday, April 22, 2015 10:33 AM
To: Tyler Freeman
Subject: Notification Summary Request
Mr. Freeman,
Here is an attached file with the information you requested-thanks!
Jessie A.buckanan
Arl Asst.II
3essie5@pscleanair.org
Direct 206.689.4010
Fax 206.343.7522
pscleanair,org
Puget Sound Crean Alt Agency
1904 3rd Ave—Suite 105
Seattle,WA 98101
"Working together fr clean air"
2
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Approved Transaction 3 g OD https cure.pscleanair.org/Asbestos/Approved.aspx
ps-cleanair.org \ 7 c S
Puget sound clean Air Agency' ti9 '"1 , b r
Notification Amendment #: 20150 056-
�(`� Ga ✓
This page must be printed. A printout of the notification,all amendments to the notification,and the asbestos survey shall be available for inspection at all
times at the asbestos project or demolition site(Reg III,4.03(a)(6)).
Fee Amount Paid $20.00 p % ii 2 t)i=
Credit Card Transaction#AS1FCE24779B p1.06 �*`-�
Transaction Date 04/01/15
Owner's Name MSG Federal Way Veterans LLC Phone (253)835-7678
Project Street Address 29404 and 29400 Pacific Highway South
City Federal Way Zip 98003
Contact Person Robin Corak Phone (253)835-7678
Mailing Address 1200 South 336th
Federal Way,WA 98003
This project includes asbestos removal.
Project Size 765 linear feet / 15 square feet
Project Start Date 03/30/15 Completion Date 04/01/15
Asbestos will be removed by a licensed asbestos abatement contractor
Contractor KD&S Environmental,Inc. Contractor Job# 15-4337
Contact Sandie Pennant Phone (360) 249-5540
Mailing Address P.O.Box 312
Montesano,WA 98563
This project includes a demolition.
Demolition Start Date 03/30/15 Completion Date 03/30/15
Demolition will be completed by a demolition contractor
Demo Contractor KD&.S Environmental,Inc. Contractor Job # 15-4337
Contact Sandie Pennant Phone (360)249-5540
Mailing Address P.O.Box 312
Montesano,WA 98563
By submitting this Amendment:
(1)I certify that the information I have provided is to the best of my knowledge true and accurate.
(2) I understand the fees for this Amendment are nonrefundable.
Create Another Notification View History Lou Out
If you have questions,contact us at asbestos@pscleanair.org or 206.689.4058.
1 of 1 4/1/2015 2:55 PM
•
INC
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• DW
Z
AND 0
it 41°
Cc
Z P.O. Box 312 (360)249-5540
Yi Montesano,WA 98563 Fax(360)249-3475 1-800-339-9546 www.kdsenvironmental.com
Date: April 1,2015
RE: 29400 and 29404 Pacific Highway South Federal Way,WA.
To Whom It May Concern:
This is to inform you that all identified asbestos from the property known as 29400 and 29404 Pacific Hwy
South, Federal Way,WA. has been properly removed,transported and disposed of in accordance with all local,
state and federal regulations.
Good luck with your project.
Thank you,
Sandie Pennant/Office Manager
KD&S Environmental, Inc.
•
Tyler Freeman
From: Janel Salinas [JanelS@ShelterResourceslnc.com]
Sent: Monday, March 23, 2015 10:50 AM
To: Lee Salyer(Lee@ce-cinc.com)
Cc: Gregg@ce-cinc.com; Darrell Barnes(Darrell@ce-cinc.com); Mark E Thometz
Subject: Federal Way Vets-Gas Line-Cut and Cap
Dear Lee,
Contrary to information received from Synergy with regards to no efforts on the demolition process; I received a phone
call from Infra Source,the gas contractor from PSE and the lines have already been cut and capped back to the property
line along Highway 99. This was apparently completed on December 3, 2014. Please, during your due diligence and
demo permit sign off,feel free to contact Charlotte at(253) 328-1810 with any questions,concerns or location of cap.
Thank you,
Janel
Janel Salinas
Shelter Resources, Inc.
2223 112th Avenue NE, Suite 102
Bellevue, Washington 98004
(425) 454-8205 Ext. 219
(425) 455-8546 Fax
janels(a�shelterresourcesinc.com
No trees were killed in the process of sending this message. However a large number of electrons were terribly
inconvenienced... :)
1
5c 4-c S ys+e k) '"- t,Oet.l
,
Elliott, Ken
To: Tyler Freeman
Subject: RE: Federal Way Veterans Center- Demoliton Permit Checklist 1
1
Hi Tyler.Regarding Item#3.Septic System.The regulation of septic system abandonment is King County Board of Health
Title 13.04.054—see code attached. Once I receive the completed Tank Abandonment form (attached) I can sign under
Item#3.For Item#9:Private Well.The State-licensed well driller would obtain a Start Card from the State Dept.of
Ecology.Driller would file a Request for Notification of Decommissioning with Health in advance of starting the job so
that we have the opportunity to witness this abandonment activity—we have a cooperative agreement with D.O.E.for
this.Once the well abandonment is complete,the driller is required to submit the well log to D.O.E.to finalize; hence
D.O.E.should sign under Item#9 as the abandonment of well needs to be in compliance with State WAC 173-160 which
they enforce.Call if any questions.
Regards,
Ken Elliott, R.S.
Seattle-King County Dept.of Public Health
206-477-8032
From:Tyler Freeman [mailto:Tvler.Freeman@fbc-d.com]
Sent: Wednesday,April 22, 2015 9:13 AM
To: Elliott, Ken 'E
Subject: Federal Way Veterans Center- Demoliton Permit Checklist
Good Morning Ken,
As we just discussed on the phone, attached is the Federal Way Demolition Permit Application. As you can see there are
two areas that King County Environmental Services needs to be aware of;
Septic System and Water—Private Well.
We will be decommissioning 2 septic tanks and one private water well once we get onsite next week. Currently we will
be using Northwest Cascade and Nicholson drilling respectively to finish this work.
I am looking for an email back to confirm that you and I have discussed this plan and King County understands our
intentions going forward.
Please let me know if you have any questions on this.
Thank you and have a great day!
{
Tyler Freeman
Project/Office Manager
FREEMAN BELL CONSTRUCTION AND DEVELOPMENT,LLC.
P: (253)268-3945
F: (253)466-3353
C: (253)509-2322
www.fbc-d.com
1
i
Public Health ��``le,,,
I
. Seattle & King Count
REPORT OF WASTEWATER TANK ABANDONMENT
Return completed form to Public Health—Seattle&King County,Environmental Health Division, 14350 SE Eastgate Way,
Bellevue,WA,98007,Tel.(206 296-4932. Faxed co ies will not be accepted due to data entry purposes.
DATE: / /
PARCEL(APN): 3 0 4 O Z. 0 0.0 7
6
Instructions for completing form: This form is to be completed by any persons permanently removing a
septic tank, seepage pit, cesspool, or other on-site sewage system wastewater tanks from service.
Complete and submit this report to the health officer within thirty (30) days of the abandonment.
Authority: Chapter 13.04.054,the Code of King County Board of Health, Title 13.
General Information (Please print):
Name of Owner/Occupant of Property: �Vl� Peck Ya( vtaa y Ve-}e retvt5 1 1-L.G.-
Address: I ZOO Sov 33Co , Federal Way , IA)/- gBoo 3
Wastewater Tank Data:
Type of Sewage Tank: X Septic Tank Pump Tank Holding Tank ,Other:
Number of Compartments Pumped: 1--
Number
Number of Gallons Pumped: 500
Checklist Item Yes No Not Applicable Comments
Septage removed by an approved pumper?* I
Tank lid removed or destroyed? I
Tank void filled with compacted soil or /
gravel? V
*OSS Pumper Name:
King County Certification Number:
Reason for wastewater tank abandonment:
Property being served by public sewers Property being served by replacement tank
/Structure being demolished
Comments:
Report of Wastewater Tank Abandonment Revised 11/9/2012
. .
. . . .
• 0
Public Health
La
C
d��""� '0
. Seattle & King Count
REPORT OF WASTEWATER TANK ABANDONMENT
Return completed form to Public Health—Seattle&King County,Environmental Health Division, 14350 SE Eastgate Way,
Bellevue,WA,98007,Tel. 206 296-4932. Faxed co ies will not be accepted due to data entry purposes.
DATE: / /
PARCEL(APN): 3 O t{ 0 Z 0 0 0 B 1-
tt
Instructions for completing form: This form is to be completed by any persons permanently removing a
septic tank, seepage pit, cesspool, or other on-site sewage system wastewater tanks from service.
Complete and submit this report to the health officer within thirty (30) days of the abandonment.
Authority: Chapter 13.04.054, the Code of King County Board of Health,Title 13.
General Information (Please print):
Name of Owner/Occupant of Property: V/SC F cievrce1 Later Ve-k-e- 5? (LC-•
Address: p 7 co , 50.A-k 33r` i pec1e Yce1 ,tai%,�, ( .)fir 2 C3
Wastewater Tank Data:
Type of Sewage Tank: ?( Septic Tank _Pump Tank —Holding Tank Other:
Number of Compartments Pumped: 1
Number of Gallons Pumped: 100 0
Checklist Item Yes No Not Applicable Comments
Septage removed by an approved pumper?* ✓ _
Tank lid removed or destroyed?
Tank void filled with compacted soil or /
gravel? �/
*OSS Pumper Name:
King County Certification Number:
Reason for wastewater tank abandonment:
Property being served by public sewers Property being served by replacement tank
IStructure being demolished
Comments:
Report of Wastewater Tank Abandonment Revised 11/9/2012
_iL�-
' M • I • a 0."�CV 4'-v;;C,e
Tyler Freeman
From: Kathy Brown [KBrown@lakehaven.org]
Sent: Thursday, April 16, 2015 8:11 AM
To: Tyler Freeman; Janet Salinas
Subject: RE: Freeman Bell Water Meter Abandonment Application
Attachments: WSCR 30772.pdf
Tyler&Janet,
Attached is a copy of the water service record to remove the existing meter and abandon the water service line back to
the main for APN 3040200079, 29400 Pacific Hwy South. The work will be performed by our Field crew. The owner is
charged actual time&material. A deposit of$3,440.00 will be collected. Any overage is refunded; deficit is invoiced.
We will also need to obtain a right-of-way permit,so the total owing is$3,780.00.
A representative from the Multi Service Center should contact Julie in our Billing Dept.at 253-945-1614 or
ikrienerthomas@lakehaven.org to request a Billing Agreement on Account No.480703, 29404 Pacific Hwy South. This
will allow us to bill CE&C for the bi-monthly water bills.
Please contact Chris Zoepfl,our Cross Connection Manager, regarding the double check valve. He can be reached at
253-946-5427 or czoepfl@lakehaven.org. This existing meter is a 5/8"x 3/4"size.
Let me know if you have further questions.
Kathy Brown
Lakehaven Utility District
Ph: 253-945-1580
Fax: 253-529-4081
kbrown@lakehaven.org
NOTE: Lakehaven Utility District neither warrants nor guarantees the accuracy of any facility information provided.
Facility locations and conditions are subject to field verification. All fees and charges subject to change without notice.
From: Christie Jenkins-House
Sent: Friday, April 10, 2015 3:03 PM
To: 'Tyler Freeman'
Cc: 'JanelS@ShelterResourcesInc.com'; Kathy Brown
Subject: RE: Freeman Bell Water Meter Abandonment Application
Hi Tyler,
Since Kathy Brown has been working with Janet on this project I'm going to forward this email to her. I spoke briefly
with Janet and told her Kathy would be back in the office on Monday. I had no idea you and Janet were involved with
this project. I'm going to let Kathy get back to you with the costs and any other information you might need. I will fill
her in on your decision to abandon the residential meter and keep the commercial meter for construction use. I will
pass on the application to Kathy. Once the deposit amount required for abandoning the meter has been determined we
will notify you that the application has been processed and is ready for payment. We show Multi Service Center as the
current owner of the property. Our Billing Department will need to be notified of any changes to the ownership of the
property.Thanks.
Christie House
Office Assistant III
1
• •
LAKEHAVEN UTILITY DISTRICT
WATER SERVICE CONNECTION RECORD
SERVICE NO. 4805 STATUSAPPLICATION NO.1.-- )772
APPLICATION DATE I- /15/ SLI DATE � SUPERSEDES 27657.
SERVICE LINE SIZE MTR SIZE MTR INST DATE
SERVICE LINE I METER NO. � READING
INSTALLED BY METER MAKE/MODEL I
METER LOCATION I CC INSP.DATE
ROUTE I WATER ACCOUNT NO.I SEQ.BEFORE
SERVICE House# Street Name Suite ID City State Zip Cod
ADDRESS 119400 (PACIFIC HWY SFEDERAL,WAY
WA 98003-,
LOT#(S) PTN 4 BLOCK#(S) 1 PLAT/BSP/BLA (HALLS ACRE TRACTS
TAX PARCEL NO. 3040200079 GRID K-OS
OWNER MULTI SERVICE CENTER PHONE 1175775--36-58 ext. I-
BILLING House# Street Name Suite ID City State Zip Cod
ADDRESS I—IP 0 BOX 23699 IFEDERAL WAY WA 98093
OWNER CONTACT MARK THOMETZ , PHONE (206)..818-2398. ext.
CLASSIFICATION (RESIDENTIAL NUMBER OF UNITS 1 , ERU CREDITS r-
-7
SVC TYPE (SERVICE ABANDONMENT TMP WTR SVC ❑ FIRE SPRINK❑ WATER ULID
SPECIAL CONDITIONS IREMOVE EXISTING METER&SERVICE BACK TO MAIN
ESTIMATED WATER PRESSURE: MINIMUM 1-7 psi MAXIMUM 63`. psi
INDIVIDUAL PRESSURE REDUCING VALVE: INOT RECOMMENDED . .. ._
INDIVIDUAL BOOSTER PUMP: (DISCOURAGED
WATER SERVICE SEPARATION/UPGRADE: IREOUIRED IF PUMP INSTALLED
LOW PRESSURE WATER SERVICE AGRMT: INOT REQUIRED IF PUMP INSTALLED
FEES AND CHARGES:
CHARGES PAYABLE IN LIEU OF EXTENSION r $0.00
CFC ,. $0.00
AREA CHARGE $0.00
SERVICE CONNECTION INSTALLATION DEPOSIT 1—$7,777:
SERVICE CONNECTION INSTALLATION CHARGE
METER INSTALLATION CHARGE $0.00
RIGHT-OF-WAY PERMIT .$340.00_:
RIGHT-OF-WAY PERMIT $0.00
SERVICE CONNECTION AGREEMENT CHARGES $0.00
DATE PAID TOTAL $3,780.00
RECEIPT#I ;
Application Accepted SIGNATURE OF
AUTHORIZED LAKEHAVEN REPRESENTATIVE
This day of , By:
NO. 30772
• •
LAKEHAYEN UTILITY DISTRICT
SERVICE CONNECTION APPLICATION
Please type or print legibly.All shaded fields/information required.
(Check One or Both)
WATER SERVICE CONNECTION/METER INSTALLATION(SITE/METER PLAN REQUIRED)
SEWER SERVICE CONNECTION(SITE PLAN REQUIRED)
PROPERTY INFORMATION
Building/Property Address 29 go Pet Gi{I L (--j9t4wct�` 50
Address City I r�e,ral Oaf State I State wf{ I Zip q8CO3
Tax Parcel No. 3011020 - 0081 I Property Area square feet
Plat/BSP/BLA Recording#
Lot#(s) Block#(s)
Attach Legal Property Description to Service Connection Application Form on Separate Sheet
Property Elevations(NGVD-29 High Law Source of Information
datum)
Yes No If"Yes",List Service Number(s)
Previous Connection(s)to Water?
Yes No If"Yes",List Service Number(s)
Previous Connection(s)to Sewer?
PROPERTY OWNER INFORMATION
Owner Name(s) 11ASL. Fe.cleru.1 Witti Veiercens, L�C• I Phone# 253- 83s-7!078
Address I 12_00 Sovi'h 33(0'`
Mailing Address
City I Feckemk Wal I State I llrn I Zip 198 3
Email '4 a fed v.1aiD C-O vvCas+. he-E Fax#
Contact Name �/I/�ar� pw,e-}Z Phone# 12 -Na.23/61 Ext
Contact Email - .fi)cov,nca.S4 vtt-f Contact Fax#
BUILDING/SITE INFORMATION
Finished Floor Elevations High Low Source of Information
(NGVD-29 datum)
Bldg.Area square feet #MFR Units Irrigation ❑ Fire Sprinklers ❑
Business Type(describe if necessary)
-_-_ WATER SERVICE INFORMATION
New-Full w/meter❑ New-Stub w/o meter El Existing-Upsize❑ *Existing-Abandonment
Permanent❑ Temporary(perm.service/temp. location)El Short Term(e.g.,project terms)❑
Residential ❑ Multi-Family ❑ Commercial/Non-res. [ir.
Classification
Public Authority ❑ Irrigation ❑ Fire Protection ❑
Fire n System Demand(GPM,if residential(SFR or MFR)fire protection system is proposed):
SEWER SERVICE INFORMATION (attach site plan)
New-Full(Bldg.Connection) ❑ New-Stub Only El Repair❑ *Existing-Disconnect❑
Permanent El Temporary(perm.service/temp. location)❑ Short Term(e.g.,project terms)El
Residential ❑ Multi-Family ❑ Commercial/Non-res. ❑
Classification Public Authority ❑
Contractor Phone#
Contact Phone#
Email Fax#
Grinder Pump(if applicable) ❑ Make Model
Continued on Page 2-->-->
ServConn App-2013REV.docx(Form Rev. 10/11/13) Page 1 of 2
• S
LAKEHAVEN UTILITY DISTRICT
SERVICE CONNECTION APPLICATION
Please type or print legibly.All shaded fields/information required.
RESIDENTIAL PLUMBING FIXTURE INFORMATION
(in accordance with the Uniform Plumbing Code)
Fixture Total# X TotalCt.
Bathtub or Combination Bath/Shower with'/2"Fill Valve 4.0
Bathtub or Combination Bath/Shower with 3/a"Fill Valve 10.0
Clothes Washer 4.0
Dishwasher,(domestic,built-in) 1.5
Hose Bibb/Spigot/External Faucet(1st) 2.5
Hose Bibb/Spigot/External Faucet(each additional) 1.0
Sink(Kitchen,domestic) 1.5
Sink(Lavatory/Bathroom,Bar) 1.0
Sink(Laundry/Wash Tub) 1.5
Shower Stall,per head(separate from Bathtub) 2.0
Water Closet/Toilet(1.6 GPF Gravity or Flushometer Tank) 2.5
Water Closet/Toilet(greater than 1.6 GPF Gravity Tank) 3.0
Total UPC Fixture Count
NOTE-Below information required for all commercial(non-residential),irrigation&public authority water&/or sewer service connection applications.
Annual Gallons used to calculate Capital Facilities Charges. Max/Min rates used for water service/meter sizing.
Max rate=most fixtures anticipated on at the same time.Min rate=least fixtures anticipated on at the same time,but not zero(0).
If tenant info is not known at the time of application,a Z'/"Service Stub Connection may be installed to accommodate S/8"x3/4"-1'A"size meters later
NON-RESIDENTIAL SYSTEM USAGE INFORMATION -
Applicant's Estimated Water Annual(gals) Max.Rate(GPM) Min.Rate(GPM)
Usage Data
***PROPERTIES OTHER THAN SINGLEIEAMILY-RESIDENTIAL PROPERTIES,WIT NEW OR MODIFIED SERVICE CONNECTION AFTER 12/3112007,MAY BE CHARGED
FOR USAGE EXCEEDING ACQUIRED SYSTEM CAPACITY***
Length of Private Water Supply Line(Meter to Building—commercial&public authority only) feet
1" ❑ 11/2" ❑ 5/8"x3/4"❑ 1" ❑
Requested Water Service Line 2" ❑ 3" ❑ Requested Water Meter 11/2" ❑ 2" ❑
Size 4" ❑ 6" ❑ Size 3" ❑ 4" ❑
8" ❑ 6" ❑ 8" ❑
ALL APPLICATIONS(attach,as applicable):Private Utility Easements
NON-RESIDENTIAL APPLICATIONS(attach,required):Water Use Questionnaire&Sewer Use Survey
*-Legal Property Owner Signature required for service disconnects/abandonments
As owner,or with express permission of the owner,of the subject property,I hereby apply for water and/or sanitary sewer service in accordance with the current rules
and regulations of Lakehaven Utility District(Lakehaven),or such rules and regulations of Lakehaven as hereafter made or amended. In addition,I acknowledge,agree
to,and certify,by my signature below,the following:
• Applicant hereby agrees to identify property corners and/or easement boundaries to assist with the proper location of the water meter(s),and that clearly marked
stakes will be used for such purpose. Applicant hereby acknowledges Lakehaven's recommendation,for properties that have not been surveyed,that Applicant
secure at Applicant's expense the services of a licensed land surveyor to locate and document the property corners and/or easement boundaries. In the event of any
errors relative to staking or marking,Applicant hereby agrees to pay all costs to Lakehaven to abandon the installed meter,and to relocate and install a meter in
the correct location,including applicable deposits for the work.
• Applicant understands and by his/her signature to this application agrees to indemnify,defend and hold harmless Lakehaven,its agents and employees from and
against any and all claims,losses or liability,including attorney's fees arising from injury or death to persons or damage to property occasioned by any act,
omission or failure of the Applicant,his officers,agents and employees,in performing the work authorized by this permit. This paragraph shall not apply to any
damage resulting from the sole negligence of Lakehaven,its agents and employees. To the extent any of the damages referenced by this paragraph were caused
by or resulted from the concurrent negligence of Lakehaven, its agents or employees, this obligation to indemnify, defend and hold harmless is valid and
enforceable only to the extent of the negligence of the,his officers,agents and employees.
• Applicant agrees to allow Lakehaven personnel to enter onto Applicant's property as, or if,necessary for the purpose of recording water usage, &/or other
necessary operation&maintenance tasks performed on Lakehaven-owned water system facilities.
• It is Applicant's responsibility to know Lakehaven's requirements and any applicable City,County,or State requirements or regulations. Lakehaven may waive
any of the above requirements. Such waiver or waiver by acquiescence by Lakehaven of any provisions or conditions stated above shall not be a waiver of any
other provision or condition of this permit.
• I hereby certify that the information provided on this application is true and correct and that the applicable requirements of Lakehaven will be met. Missing and/or
incomplete information will delay processing.
• Application will expire 30 days after date of application,without notice,and a new application will be required to be submitted at that time. Service connection
costs are subject to applicable fees,charges,&deposits at the time a complete application for service is received by Lakehaven.
(*Signature) (Date)
ServConn App-2013REV.docx(Form Rev. 10/11/13) Page 2 of 2
•
LAKEHAVEN UTILITY DISTRICTS
SERVICE CONNECTION APPLICATION
Please type or print legibly.All shaded fields/information required.
(Check One or Both)
WATER SERVICE CONNECTION/METER INSTALLATION(SITE/METER PLAN REQUIRED)
SEWER SERVICE CONNECTION(SITE PLAN REQUIRED)
PROPERTY INFORMATION
Building/Property Address Zotfoo Rt ;¢ie E}19kwai 5pv-KA.
Address City feclera\ tray State wA Zip q8c03
3
Tax Parcel No. Argo 20 - C01°1 Property Area square feet
Plat/BSP/BLA Recording#
Lot#(s) Block#(s)
Attach Legal Property Description to Service Connection Application Form on Separate Sheet
Property Elevations(NGVD-29 High Low Source of Information
datum)
Yes No If"Yes",List Service Number(s)
Previous Connection(s)to Water?
Yes No If"Yes",List Service Number(s)
Previous Connection(s)to Sewer?
PROPERTY OWNER INFORMATION
Owner Name(s) ('t5p- k_ Wal Ue'ce ws, LLG. Phone# 2.53-$351406
Address 12,00 Sa, 3311;*'
Mailing Address
City Pel e✓etk tA115 State WA Zip 9E00 3
Email
114 e-fed to AQ cow,casa-.tne l- Fax#
Contact Name t r-G. "('[,iom 4 Phone# Ext
Contact Email LL- - W0.Q eowicos,i-,yid- Contact Fax#
BUILDING/SITE INFORMATION
Finished Floor Elevations High Low Source of Information
(NGVD-29 datum)
Bldg.Area square feet #MFR Units Irrigation ❑ Fire Sprinklers ❑
Business Type(describe if necessary)
WATER SERVICE INFORMATION ■_
New-Full w/meter❑ New-Stub w/o meter❑ Existing-Upsize❑ *Existing-Abandonment
Permanent❑ Temporary(perm.service/temp. location)❑ Short Term(e.g.,project terms)❑
Classification
Residential 4 Multi-Family ❑ Commercial/Non-res. ❑
Public Authority ❑ Irrigation ❑ Fire Protection ❑
Fire Protection Demand(GPM,if residential(SFR or MFR)fire protection system is proposed):
SEWER SERVICE INFORMATION(attach site plan)
New-Full(Bldg.Connection) ❑ New-Stub Only❑ Repair❑ *Existing-Disconnect❑
Permanent❑ Temporary(perm. service/temp.location) ❑ Short Term(e.g.,project terms)❑
Residential ❑ Multi-Family ❑ Commercial/Non-res. ❑
Classification
Public Authority ❑
Contractor Phone#
Contact Phone#
Email Fax#
Grinder Pump(if applicable) ❑ Make Model
Continued on Page 2—>-*
ServConn App-2013REV.docx(Form.Rev.10/11/13) Page 1 of 2
•
LAKEHAYEN UTILITY DISTRICT
SERVICE CONNECTION APPLICATION
Please type or print legibly.All shaded fields/information required.
WI . RESIDENTIAL PLUMBING FIXTURE INFORMATION
(in accordance with the Uniform Plumbing Code)
Fixture Total# X Total Ct.
Bathtub or Combination Bath/Shower with'A"Fill Valve 4.0
Bathtub or Combination Bath/Shower with 3/4"Fill Valve 10.0
Clothes Washer 4.0
Dishwasher,(domestic,built-in) 1.5
Hose Bibb/Spigot/External Faucet(1st) 2.5
Hose Bibb/Spigot/External Faucet(each additional) 1.0
Sink(Kitchen,domestic) 1.5
Sink(Lavatory/Bathroom,Bar) 1.0
Sink(Laundry/Wash Tub) 1.5
Shower Stall,per head(separate from Bathtub) 2.0
Water Closet/Toilet(1.6 GPF Gravity or Flushometer Tank) 2.5
Water Closet/Toilet(greater than 1.6 GPF Gravity Tank) 3.0
Total UPC Fixture Count
NOTE-Below information required for all commercial(non-residential),irrigation&public authority water&/or sewer service connection applications.
Annual Gallons used to calculate Capital Facilities Charges. Max/Min rates used for water service/meter sizing.
Max rate=most fixtures anticipated on at the same time.Min rate=least fixtures anticipated on at the same time,but not zero(0).
1 tenant in o is not known at the time o a lication,a P/"Service Stub Connection ma be installed to accommodate 5/8"x3/4"-1'/"size meters later.
NON-RESIDENTIAL SYSTEM USAGE INFORMATION
Applicant's Estimated Water Annual(gals) Max.Rate(GPM) Min.Rate(GPM)
Usage Data.
***PROPERTIES OTHER THAN SINGLE-FAMILY-RESIDENTIAL PROPERTIES,WITH NEW OR MODIFIED SERVICE CONNECTION AFTER 12/31/2007,MAY BE CHARGED
FOR USAGE EXCEEDING ACQUIRED SYSTEM CAPACITY***
Length of Private Water Supply Line(Meter to Building—commercial&public authority only) feet
1" ❑ 1'/z" ❑ 5/8"x3/4"❑ 1" ❑
Requested Water Service Line 2" ❑ 3" ❑ Requested Water Meter 11/2" ❑ 2" ❑
Size 4" ❑ 6" ❑ Size 3" ❑ 4" ❑
8" ❑ 6" ❑ 8" ❑
ALL APPLICATIONS(attach,as applicable);Private Utility Easements
NON-RESIDENTIAL APPLICATIONS(attach,required):Water Use Questionnaire&Sewer Use Survey
*-Legal Property Owner Signature required for service disconnects/abandonments
As owner,or with express permission of the owner,of the subject property,I hereby apply for water and/or sanitary sewer service in accordance with the current rules
and regulations of Lakehaven Utility District(Lakehaven),or such rules and regulations of Lakehaven as hereafter made or amended. In addition,I acknowledge,agree
to,and certify,by my signature below,the following:
• Applicant hereby agrees to identify property corners and/or easement boundaries to assist with the proper location of the water meter(s),and that clearly marked
stakes will be used for such purpose. Applicant hereby acknowledges Lakehaven's recommendation,for properties that have not been surveyed,that Applicant
secure at Applicant's expense the services of a licensed land surveyor to locate and document the property corners and/or easement boundaries. In the event of any
errors relative to staking or marking,Applicant hereby agrees to pay all costs to Lakehaven to abandon the installed meter,and to relocate and install a meter in
the correct location,including applicable deposits for the work.
• Applicant understands and by his/her signature to this application agrees to indemnify,defend and hold harmless Lakehaven,its agents and employees from and
against any and all claims, losses or liability, including attorney's fees arising from injury or death to persons or damage to property occasioned by any act,
omission or failure of the Applicant,his officers,agents and employees,in performing the work authorized by this permit. This paragraph shall not apply to any
damage resulting from the sole negligence of Lakehaven,its agents and employees. To the extent any of the damages referenced by this paragraph were caused
by or resulted from the concurrent negligence of Lakehaven, its agents or employees, this obligation to indemnify, defend and hold harmless is valid and
enforceable only to the extent of the negligence of the,his officers,agents and employees.
• Applicant agrees to allow Lakehaven personnel to enter onto Applicant's property as, or if,necessary for the purpose of recording water usage, &/or other
necessary operation&maintenance tasks performed on Lakehaven-owned water system facilities.
• It is Applicant's responsibility to know Lakehaven's requirements and any applicable City,County,or State requirements or regulations. Lakehaven may waive
any of the above requirements. Such waiver or waiver by acquiescence by Lakehaven of any provisions or conditions stated above shall not be a waiver of any
other provision or condition of this permit.
• I hereby certify that the information provided on this application is true and correct and that the applicable requirements of Lakehaven will be met. Missing and/or
incomplete information will delay processing.
• Application will expire 30 days after date of application,without notice,and a new application will be required to be submitted at that time. Service connection
costs are subject to applicable fees,charges,&deposits at the time a complete application for service is received by Lakehaven.
(*Signature) (Date)
ServConn App-20l3REV.docx(Form Rev. 10/11/13) Page 2 of 2
G (ec-f r�c,��vAik
•
•
From:Jason McCarter
Sent:Thursday,April 23, 2015 11:59 AM
To:Tyler Freeman; DouglasrTnreeman (Douglas.Freeman@fbc-d.com); Randy Bell (Randv.Bell@fbc-d.com); 'Janel
Salinas'; Mark E Thometz
Cc:Stephen Baldwin; Darrell Barnes; Gregg Warter;Cheryl Russell
Subject: FWVC PSE Power removal
Tyler,
Here is an email from PSE with photos that the power has been moved. Hopefully this will work for the demo permit.
Let me know
thanks
Jason McCarter
Project Superintendent
3224 centerst
Tacoma Wik,_98409
26&612.5122
Cel 1251279.7164
Ro/araoa tar Are The Foundrattbn ofOurBusiness
From: Lesinski, David T[mailto:david.lesinski@pse.com]
Sent:Thursday,April 23, 2015 11:32 AM
To:Jason McCarter
Cc: Kibler, Mark R
Subject: 29400 Pacific Hwy S. Federal Way,WA 98003
Hi, Jason. Here is the email you requested stating that the existing overhead electric service has been removed from the
house located at 29400,29404,29408 Pacific Hwy S. Federal Way, WA 98003, and has been re-installed on a new
temporary power poles.
Thanks much.
Dave Lesinski
Senior Engineering Specialist
PUGET SOUND ENERGY
253-395-6911 tel
253-905-4592 cell
david.lesinski@pse.com
www.pse.com
2
t �
Tyler Freeman
From: Jason McCarter[Jason.McCarter@ce-cinc.com]
Sent: Wednesday,April 22, 2015 7:18 PM
To: Tyler Freeman
Cc: Cheryl Russell; Randy Bell; Lee Salyer;Janel Salinas; Stephen Baldwin; Gregg Wailer;
Darrell Barnes; Douglas❑ffreeman; Mark E Thometz
Subject: RE: Federal Way Veterans Center-Demolition Permit and Requirements
I am meeting with PSE tomorrow at 9 am at the site(again). They say they will be able to finally move the
power. PSE was concerned with easement issues,but that seems to be resolved. As soon as the power has been
moved to the temp power poles,PSE says they will send me email confirmation. Let's hope it's by tomorrow so
we can move forward in order to get that permit by Friday.
Sent from Outlook
On Wed, Apr 22, 2015 at 6:37 PM-0700, "Tyler Freeman" <Tyler.Freeman@fbc-d.com>wrote:
Jason,
I wanted to give everyone an update on where I'm at in attaining the Demolition Permit.
I went to Lakehaven today to obtain the signatures required for the sewer and water service.
These were the most important requirements for Federal Way according to the representative I've been in contact with
the past week.
In order to assure that I had the necessary information for the other requirements, I visited Federal Way City Hall and
spoke with the rep in order double check how I was coming along.
Based on all the documentation I brought with me, we have been approved for all signatures outside of electrical. This
is the last remaining obstacle.
In order to finish this and obtain the permit, I need an email from PSE acknowledging that the power to the existing
buildings has been shut off and the meter removed. At the very least, I need a PSE confirmation email
with the plan for the electrical work to be completed.
With this, I can take the permit application and a check for the fees and have the permit within the hour.
I'm hoping to complete this Friday so let me know as soon as we are on board with PSE.
With this in hand,we should be good to go for demolition next week.
Let me know if anyone has questions on this.
Thanks,
Tyler Freeman
Project/Office Manager
FREEMAN BELL CONSTRUCTION AND DEVELOPMENT,LLC.
P: (253)268-3945
F: (253)466-3353
C: (253)509-2322
www.fbc-d.corn
5A/et Tct"14- S i °EF
Tyler Freeman
From: Perry, Lauri [Lauri.Perry@southkingfire.org]
Sent: Thursday,April 16, 2015 10:47 AM
To: Tyler Freeman
Subject: Fuel Tanks
Hi Tyler—
In response to our phone call on Tuesday, April 14th, you requested information on fuel tanks being located at
29400 Pacific Highway S. Federal Way and 29404 Pacific Highway S., Federal Way. We have no records of
fuel tanks on either of these properties.
Sincerely,
Lauri Perry
Executive Assistant
South King Fire & Rescue
31617 1st Avenue South
Federal Way, WA 98003
Lauri.perrv@@southkingfire.orq
253-946-7253
1