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Demo Permit Fee $35.00
DEMOLITION PERMIT APPLICATION Surcharge 4.50
CITY OF FEDERAL WAY Cash Bond 500.00
(Person Paying Bond)
BUILDING DIVISION
33530 First Way South �- ""
Federal Way,WA 98003 �v
(206)661-4000-Fax(206) 661-4129
AR 1 7 1998
DESCRIPTION OF Ile`YrH QC b .IAA/ f i&' -t-
PRIOR TO APPLICATION
NOTE:I understand that the following utilities shall be disconnected and services performed,if applicable,prior to issuance of the demolition permit.
All items are to be signed by the respective agency.
1. ASBESTOS REMOVAL 6. GGGAGE 1
IVO Cttf'/'Ci (/IC.C:
(Building Official)
2. ELECTRICITY (f/]7 / 7. SEPTIC TANK PUMPED AND FILLED WITH CRUSHED ROCK OR
v '. ,,,/, /'/ REMOVED/OR SEWER LINE PLUGGED AT PROPERTY LINE.(Inspection
_ required prior to backfilling).
(Puget Powe �y-31,...-s----7-e„0.,--`7
—Saver- 'io
rei'I t;.."
3. TELEPHONE 8. WATER LINE CUT AT PROPERTY LINE(well capped).Inspection required
1 prior to backfilling.
(US West) leL/ 1 - `7L-0 rem'',
4. GAS k
/� 9. ALL UNDERGROUND TANKS PUMPED AND REMOVED UNDER FIRE
• x?t: 1 / / _ r Al DEPARTMENT PERMIT PRIOR TO EXCAVATION. •
(Washington a' ral Gas)t3-3 -Set 0 '7 n////
5. WATER-DISCONNECT REQUEST 10. DELINQUENT UTILITY CHARGES PAID
W 71-0 rrMer;A N/4
INFORMATION FOR APPLICATION
TOB ADDRESS l a -SOCA 3,1%014
`0
14 $7c Cel-
LEGAL
C,LLEGAL DESCRIPTION
TAX PARCEL NO� (Attach if lengthy.)
OWNER M1 (` Asr We'Sf
ADDRESS .76'0 ide-S/ Mo1vvk --CA-eel- Ti IS41 , ok 4'706).
/ 06).
CONTRACTOR.. I ecr - C `J 'QA- /0"1 Vair‘e-yam �ri�t("..
ADDRESS /C-.2/.0/.' / V& 74,1g ,..S) --,,s4 1t. /�dit'1.`,�e°'! Lvi 'l ic1
si •
CONTRACTOR'S LICENSE -- Eke-6-145 Ng (� W
EXPIRATION DATE 8/4:
ZIO.--- ,6*----- itiS._g -37q7
"Signature of Applicant Phone
DEMO[In.APP
REVISED 8/26/97
•
PJ ___
‘1
PUGET SOUND lir
( f ' 2ND ,/`
TI
;T
1
i �Qii ii
FEDERAL WAY mofr 1 �\�11 �.CITY LIMITS r
,1641
isp_iati;
"..mi ium
101-40
1 Filevir -
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------ -A4Mi'tgl N g 304TH
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•
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MY ojjE]EEJFfL
G BUILDING DIVISION
• E33530 First Way South
RyFederal Way WA 98003
(253)661-4000
tt Fax(253)661-4129
ASBESTOS REMOVAL AND DISPOSAL
Permittee:
As the holder of a Demolition Permit and/or a Remodeling Permit, you are hereby notified of the possibility that
asbestos may be present in the structure that you are about to demolish and/or remodel.
ANY ASBESTOS FOUND IN THIS STRUCTURE MUST BE REMOVED AND
DISPOSED OF AS PRESCRIBED BY STATE AND FEDERAL REGULATIONS.
Permits for asbestos removal must be obtained from the Puget Sound Air Pollution Control Agency. The
permittee is responsible for obtaining any necessary asbestos removal and/or repair permits. The City of Federal
Way will not be responsible for any actions or fines levied by the federal, state, or regional agencies. Any fines
levied against the City of Federal Way must be paid by the permittee.
STATE OF WASHINGTON )
) SS
COUNTY OF KING )
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 have read and understand the statement above and I will obtain all permits
necessary or required for proper asbestos removal or repair. I agree to pay any fines against the undersigned
and/or the City of Federal Way relating to asbestos removal, repair, and/or handling; and will defend, indemnify,
and hold the city harmless from any loss, including fines, fees, or attorney fees incurred by the city relating to
asbestos removal, repair, and/or handling and arising out of the activities carried on pursuant to Permit N°
3/"11
Date 'ermittee
SUBSCRIBED and SWORN before me this day of, Q-i'd&i 1996 .
I. inciak1
HOLLY R. HEIMDAHL 1
STATE OF WASHINGTON Notary Public in and for the State of Washington,
NOTARY--.-- PUBLIC residing at kj
uY LOUUISSION EXPIRES 10-25-99 - 02,5-9-
My commission expires
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