01-102683 •
• City of Federal Way Permit #:01 - 102683 - 00 - DE
33530
C u1nsitytWay DevelopmentS Services Demolition
1s
Federal Way,WA 98003-6210
. Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: GOODYEAR •
Project Address: 31629 PACIFIC S Parcel Number: 082104 9264
Project Description: DEMO-Demolition and removal of Goodyear store in its entirety including slab on grade. This is part
of Pavilion Center Phase II A.
Owner Applicant Contractor
PAVILION CENTER ASSOC NONE S D DEACON CORP OF WASHINGTON
3650 131ST AVE SE#205 PO BOX 3070
BELLEVUE WA BELLEVUE WA 98009
98006-1334 NONE
•
•
PERMIT EXPIRES January 5,2002,IF NO WORK IS STARTED.
Permit issued on July 9,2001
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: Date: 7-%-O%
u�IZ
•
•
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1
S- 7-01 ; 1 O:22AM;Harsch Investment Med i ca l-Dental ; 15`70,322742093 #lJ �9
•oc _ 77
cRrOf CONSTRUC. I ION PERMIT APPLICATION
VV may. — ' ( L) APPLICATION NUMBER: 0 i — L p a EL27 —
APPLICATION NUMBER: L/1 - 16 a 6 el 4 -op
JUL 0 9 2°111\ APPLICATION NUMBER: - -
**The following is re i Xormation-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■. PROPERTY INFORMATION
SITE ADDRESS: 3 I IG --1 V ik -i FI(-- Orki.1 Co LoW. ASSESSOR'S TAX/PARCEL##: 7BZ i 0J_ -q 4
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): -
-y=-- .:.::K . . ._ .■ PROJECT INFORMATION . ;-' - . . .
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
.� 0 111-1,1 . ,�2i-I o1/410t_ OF- BUI L.-0 W U. `i coo ,c)c �f Oet __
1-i4CAu.N)S. t � '. .
PRCJECT NAME: r Pkki I LI 0IL ��KIT1Z-e_. d.-.=--
'1 is PEOPLE INFORMATION. ..
,
PROPERTY OWNER: NAME. (( DAYTIME PHONE:
* -7-I•A�fcci NT "1}2.
cUpl�K-I S L-I_C, (20(e )6Z;-‘4,0b
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
.50( CI,I\IC . SCA,T( Ib(7t , SEA-MC SEA- L+ A- 9 8 Iv 1
CONTRACTOR: NA"� y, DAYTIME PHONE:
-._> , l 1 bQ v (Oe-? Est (\'' (Zo 4' ) .67I -27 ( (f7
MAIUG ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
�".. t770i
&70 i �u..ovLIE , RT&&Oei ( ) c7/41•41E,
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
2 — 00 - / 01 / 42 -00 - 131- (2 3 ) `2-6 -10c0(
CONTRACTOR'S REGISTRATION NUMBER: (x(13 i EXPIRA ON DATE:
(copy of card required) --D`C ) fes-W I 0 E N T (40 I /Z'S-1 (85'a / / /ZOO L
APPLICANT: NAME: DAYTIME PHONE:
( ) -
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
( )
RELATIONSHIP TO PROJECT: FAX NUMBER: i
❑ ARCHITECT 0 TENANT ❑ OTHER(DESCRIBE): ( ) - .
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT CONTRACTOR
':::;1-:::::•':`: :.:.:-.,.:"%!--,: - :S--f'- : . . __ '=e . .■ :DETAILED BUILDING INFORMATION .,; . - - -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ / BOO cp
SPRINKLERED BUILDING? LI YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES 0 NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN ❑ HIGHLINE 0 PRIVATE(SEPTIC)
5- 7-O1 ; 1O:22P.M;Harscn 'investment Med lcal-DentaI ; 15032742093 # 5/ 9
III •
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
- . }.:.. .
. .--. .. .. ::;•-----.. .._ :•...-.:4. PROJECT FLOOR AREAS ,.. . .. _ _ .- ..
FLOOR EXISTING SQ. FT. PROPOSED SQ. FT. ,TOTAL
BASEMENT
FIRST I
J
SECOND
,
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
= r `' ; ' ■'. IXC ES ., _ - :-f.
Indicate number of each type of fixture
/ MECHANICAL
_ AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) /` FIREPLACE INSERT(S) RANGE(S) v MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC Cl GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
'RINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC. ( )
INTERCEPTOR(S) SUMP(S)
`=: ` , DISCLAIM ER/SIGNATURE BLOCK :.:
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 the permit application is made. 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 of
Federal Way,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 a a part of this application.
— — 1 b /cc
NAME/TITLE: �,� e DATE:
❑ PROPERTY OWNER ❑ APPLICANT i5l4ONTRACTOR
FOR OFFICE USE ONLY:
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION : BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES 0 NO CHANGE OF USE? Cl YES 0 NO
0‘,1P71392,1 11,11 .... 251560E11 SDD PAVILION II SW PAGE 0?
IP _
DEMOL1110N PERMIT APPLICATION . _v7--r-iiiimililliMINEMIIIIIIIIImurlil
rnimilENNIIIIIN moo
CITY Of FEDERAL WAY I (Perm Po*IWO
, 1
BUILDING DIVISION
. 33530 MMM
11 NEMil111111M111111.11.01111111
Yost Way South 11
Padua/Way,WA 9$003 1.10.11.11111111.111111111. , 11111=016101all
CIA 66L-400D-Prix(253)661.4129
JUL 0 9 2001
DESCRIPTION OF Wow--. 6)F.- ()mot:WELL 1?Lb6. CI 1Y Of- i-LUaiRAL WAY
- CuiLutrin utP I.
0...
MON TO APPLICATION
s• I ensderoand that die folinvvingettittIar tali be disconneeted end as performet4 rapplicable,prior to ietuance crag denselidettpetent.
ore tv ber rignsad by tirc respeetive agony.
. '
" 1. Ammo!REMOVAL 6. GIOLSAUR
—........ --- —
: 2.3. atscrittary. )ugdul-;Off,ghos: .. 0 SEP=TANK PtIMPS.D ARO ALM=Venni=SoCa Oa
=QM AT raorgATINIIIk(Inspection
mOnsl ' 410 — L11 .
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tt 4 ali
19Tflz. awATiuni-. AT PaOrgart ups(ivie braption toquitod
, .
4. Om9. AutAtistAMCITAISO rano AND ,-, • 1-WORMS
.4" .7. --/ A' opmcn.titirr mans=To lacrAvAnovi.
Gas) •
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INFORMATION • 44 ICATI• a,
.Toto itroun _ I C ,Is $1 • A. __,L. • U if 01 ° A it . 1111111 VP
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EXIMILATIONPM:a .....••••••................... .......,
SigUatilll,of Applicant Phone
narntrrr 17/4.
05/24/01 11:41 FAX 206 467_8584 _ MED DENT_BLDG_ __ 2002/002
•
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•
Demo Permit Fee "-I Sitt00
DEMOLITION PERMIT APPLICATION sur : 4S0
CITY OF FEDERAL WAY Cash Bond _ son-°°
(Person Paying Boal
BUILDING DIVISION
33530 Fust Way South
Federal Way,WA 98003
•
(253)661-4000-Fax(253) 661-4129 JUL 0 (Li¢i.f d .
-, � J CITY NUG=DTW.
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DESCRIPTION OF WORK --)e 1,1 •—
�l-
PRIOR TO APPLICATION
Arc •I understand Thal the fallowing utilities,shall be disconnected and 'cis performed,f applicable,prior to issuance of the demolition permit
lairs ars to be signed by the respective agency_
1. AsBsslos REMOVAL 6. GARBAGE
Se c
uilding Oficial)
2. P c ratcl?Y ()SEPTIC TANK PUMPED AND FILLED WITH tatUslizo ROCK CR
(it jREMOVSdCRSEWERLINE
PLUGGEDATPROPERTY LINE.(Inspection
required pri hat ,
(Puget Power)
/.),K7( „el
\($ 3: TM.EPlio ®WAS LINE art AT PROPERTY LII (wcU capped).Inspection requited
%.e-� 1,1-cprior to bacldiling,
(US West) f i
ig 4. GAs ' 9. ALL uttIDERGROUND TANKS PUMPED AHD REMOVED D UNDERFIEE
C A PS E DEEAktmiNTmbar PRIORTOEXCAVATION.
(Washington Natural Gas)
5. WATER-DQI S1 10. DELINQUENT PAta.
4
INFORMATION FOR • -PLICATIO
JOB ADDRESS I L ma a • 1,6a-1_ L • . _ II •,
LEGALDesca PTION + ,iiI��-r '4?
TAxPAwaz lJ l0 VOL' (Attach iflengthy.)
()weal frnrain \ veAc-- ro• -h. L-1.-C_
ADDRESS a . 461 -rod (� S # _�� I • •
CoNTRacPOR ` 1 —
ADDRESS
CONrRACrak's Llc s
(C4'P9"sec)
EXPIRATION DATE
ac3te7 T TAVLolZ_ Q5�-5a
Signature of Applicant Phone
DAM=ADP
06/18/01 14:28 FAX 206 467 8584 MED DENT BLDG U 001/002
_ . ��...� ...,. �.._..� ..... ...... �.. - 1,1„. ra.ora.ac...ac.a... • YwY CJnr..n arra LEI UU
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Agency Casa No. 1� R
, ` PUGETSOUND CLEANAIAG. Y DInto Received
110 Union Serest;Suitt 500 (✓
2 0 0 ! 0 1 9 7 4 .- ' S'"1 `r seetM : ` l:,WA 98101-2038
www.pscleannir.org
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.fy.enn•Use On i:1- iiiiiiiiiii NOTICE OF INTh.N " J UL () /tqi`a
A. Project Type: j I. l.3 Asbestos Removal •2.® Asbestn5 Removal&Demolition ' 3. ❑ Demolition,No is- limos Removal
B. -
?repos--O„•re-: Marsch Invest-Montsphone, (206) 623-4096
Mailing Address: 509 Olive Way, Suite 1062 City: Seattle State WA Zip: 96101
C. Asbe cos ret+.rdPR1•V7CLEsfLt:rmaiv=INMLR REM MI.u..rrrv6L.taf
Contractor: TLH environmental , Inc. chimer/CEO: Timothy P. 020g
Contractor
)Niihau_\1I11rc.t s: 9221 Roosevelt Wa NE Phone: (206) 523-4141 Job No.:
Ci;a: Seattle 3t-[e: WA Zip: 98115 Fal: 206) 522-4099 5618
D. Sift - —
Address: 31629 Pacific Ewy. South City, Federal Way , z ,. 98003
Site
\teenager: Locn1 Phone:
E. Asbestos Survey or No. of Date Asbestos Survey Was Asbestos Found? &Yes
0 Mail Presumed Structures: 1 «as Conducted: 4/4/2001 Q If No,Attach curve'
.+.t JIIELI Si Alt) tiAtiv(MG 9dfoni ALL OL:erutrrrar PROJEM No_of Structures Surveyed:
,AHERA 13uildinu inspector: JT 1;nvironmental, BX"t:ce Thoreen (Attach man ifmultiolc units) 1
Ccrtiticauon `u.: 538548868.03
an.Date: 1/22/02 I Starr_ WA
R. D&-nulition Srart ` I No.or 17Ttzining Fire-List Fire Dept.)
Infurnrariunt D:1rc: 2001 Structures: 5/30/2001 ?❑ 0rdzr.d De:roiirion(_[tach caov of Urdcr)
Demolition lustre dealnhIPgg t•nnrructur..r n.mlins od!lre,s(n baton Phone. (425) 454-5038
C. .-sbe5t0s ?roject ' work Dazs: M T w Th F Sa Su
inforrnntinn: St:1rt Datc: 4/21/2001 Cunt Ietion Dam: 4/30/2001 Hours: 7:OOA -- 5:O0P
• No,of Structures Surycvcd:
Tota!Qty, to be Removed: Linear Ft 2028 S.',are F . r- c ma u ' It units
Thertnal System In.ut_tiori: 130110r1FUmacc Ila_ • Duct Ins_ N Pipe Ins. Other SV, VAT & MaSt1G
Suer Cine M:1(.1: 1 Firepro& r'' Paints Pfister Tenured Coning$ Uthcr
disc. \1at'l Cement 8d. Cement Pipe LJ Fnsble Flooring orRoofing Mar'I I Other:
1-L .asbesragiDnmalitian Project Cotegorice7 =ficution_Perinci Proiccr FQ9 Ailieslyll
I, Sin C-Famne
ily Relidce: (Check box A 5 S for asbestos removal &dcrnolition) 5 23 Non-Refundable
A. DI Asbestos Removal Project A.Prior Notice Fee Covers Asbestos
B.0 Dctnolltiod'Proiert B. 10 Das Removal St.Demolition
-_ All Other Uctnolitiuns With No Asbestos Removal Pro icer 10 Days 5150
5 c lU•259 linear(tet 07.:=16. 159 square fee[of asbestos(sou bael,t ) 10 DrysSI 50
;, .e 2200-999 linear fact or 16e0-4,999 s.care feet of asbestos I 10 Dass S:00
' 1.000.9,90 linear feet or 5.000-49,999 square feet of asbestos ' I0 Days S750
6. > I O. gof1 linear feet or>50.000 suture feet ofasbestos _ 1 10 Das 52.000
- Erneee rice•,4sbt itos Prejaet or ❑ Emer¢m Demolition Proicet I Prior Norice ' 7.1.-ice P5niect Pe=
r
L I du hurcbr untie)/ilial the information contsinad in this notification&aupplamanra:dais deaeribaJ herein is.to the best et /t1i 'TLE Envirnmntal, Inc- 4/11/2001 ( ; ,
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5i.enan.re Represe>+rinp Dmc i
PSAPCA Fora No.be.160(Reis+d 9100)At-I '1 'ti
1 J v) Li
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L.,
06/18/01 14:28 FAX 2467 8584 MED DENT BLDG 0 0002/002
04/12/01 TflU 10:55 FAX 522 088 TLH ABATEMENT -e» PSAPCA APPS (l 003
The Puget Sound Clean Air P.gency requires advance norificatioe before any person commences a friable asbestos project
involving materials equal to or greater in size than 10 linear feet or 48 square feet and for all demolition projects (regardless of
asbestos content) involving structures with a projected roof area greater than 120 square feet (Regulation i11TFl° ucle 4). -All
asbestos removal and demolition notifications must be submitted to the Agency on current Agency forms. Asbestos removal and
demolition , o'ects ' volein- materials - • sttuentt__ below ,. orifi ation !t old are still sub'ect to all ?then •eirements of
Regul. Il, Article 4.
The Agency notification form must be used to submit a notification for an asbestos project,, a combined asbestos and demolition
- project and a demolition project where no asbestos removal is required prior to demolition. After receiving a complete notification
with the appropriate project fee, the Agency will review the form and return a copy to the asbestos and demolition contractor by
mail. The returned copy will be your validated notification.
J, Demolition pax,a.nuc' ILL n .,1 ra raw.Afrldte M4'JA WILL
Contractor: sr) Lead Owner/CEO: Steve Deacon_
Mailing Address: 1745 114th Ave. 86, Bellevue 98004 Phoac: (425) 4545038 Contractor'
_ s Job#:
City: Bellevue , states WA } zip; '. 98004 Re; (425) 454-4882 S6LE, ,
GUIDELINES FOR SUBMITTING AN ASBESTOSWEMOLITION NOTIFICATION
Step 1. Check the appropriate project type in Box A.
Step 2. Enter property owner information in Box B.
Step 3. Enter the asbestos contractor or property owner information, if the property owner is conducting a single-family residential
project, in Box C. Print clearly this is your return mailing label
Step 4. Enter the site address for all notifications in Box D. For multi-structure projects, attach supplemental sheet with a site map
(include an'address for each site)and a list ofrthe type and amount of friable asbestos co be removed from each structure.
Step S. Check asbestos survey and enter information or material presumed in Box E All demolitions require an Asbestos Haenrd
Emergency Response Act (AHER.A) asbestos survey be conducted by an AHEtRA certified building Inspector.A copy of the survey
results must be included for thole proicets.a There no asbestos was fnu urin .r cv,
Step 6. Enter the demolition project information in Box F.and check the appropriate box if the demolition is a training fire (a copy of
local fire district permit must be attached), an ordered demolition by a city or state official (a copy of the order must be attached),
Also insert the demolition contractor mailing address in BOX J on back of this form.
Step 7. Enter asbestos project information in Box G.
Step 8. For Single-Family Residential projects: check BOX HU for renovation projects, BOX HIS for demolition projects With
Ito asbestos removal and BOX H1.�and H18 for asbestos removal and demolition projects. The total project fee for single-family
residential projects is 523 regardless of category or categories chosen. Asbestos removal may be conducted after a complete
notification is received-but demolition activities can only begin on the 1011 day after the notification is received.
For Commercial asbestos projects; check the project category H2 - 6 that matches the amount of friable asbestos that will be
removed. The project category fee includes both asbestos removal and demolition.To file for an emergency asbestos or demolition
project, check the appropriate box I -.6 and the applicable emergency box in H7. Alt erne reenc' requests must b��ceo anrr;o led b�' a
letter •m the .roterty owne dentonstratin- ti. Med to conduct the .ro'ect immediate v in accordance with the re•uirement in
Regulation Ill. Section 4.03 (e).
Step 9. Please certify the accuracy and completeness of the information provided by signing the notification in Sol I.
Mandatory amendments to the notification arc required for changes that increase the project category. chance the types of asbestos
materials to be removed and work schedule changes. No fee is required for work schedule changes if the contractor is parttcipoun_
in the Agency work schedule fax program. A fifty-dollar processing fee is required for all ocher amendments.
Puget Sound Clean Air Agency asbestos regulations and forms can downloaded from the Agcncy web page at www.pscleanair.org-
For technical assistance contact(206) 689-4058 and for administrative inquiries contact(206) 689-4090.
PSAPCA Kean No.: 66.160(Rc iced 9/00)AM
PSAPCA Form No.66-160(Rcriscd 91001 AM
06/08/01 08:51 FAX 2067 8584 MED DENT BLDG 0 Cj002%008
F �J;'Env Inc FAX NO. 2064407367 May- 15 200i 09:55AM P2
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BUILDING DIVISION - �--.
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Paie:%l Way,WA NOM ..
(253)651-4003-Fax 12.53)661-4120
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DEMOLITION PERMIT APPLICATION �= .sa
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CITY OF FEbERAL WAY CP•yroa Pastas lawn
• BUILDING DIVISION
7 '30 Pint War Smith
Fedanl War,WA 92003 t
(253)651-6023.Fac R53)6d1-4i29 • E,CE! .
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LA f BUILDING DEPT.
gi�oA To ApPISCA PION
NOM I iindirabra than r/r.fallowing ublitisi Avail h di remuirerad and.ts+vima poln vist4 Tf opplieaAl.R Mier to isruvncr Oho dimoliQms peeisrL
.4.11 Rents arm t•he aiyuad by firs ns¢peaci a money.
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CBulldina rig)
2. Eraersaurr 7. SErricrooaroweo Atvo M.t.rn%sittlt=arm=acam ors
RiUtvscial Invelt LD•rfi Mull=AT MAP'E�YT LI,NS.(yseptr4on
required prior ra kole61 18)•
(7y2ctPow*
z. Wax tlfa c t AT SParL (••52 atilt �popbsm tequiwd
3. � prier to Imokiilliei&
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9, All UND GtUND t 3 3 Paul=AZA 7 D t
4. GmCOMM IT PE11341T Mot m F7cr.•.VA r1oM.
(WishilsrolAV.111014 Gas)
5. WA=-ptseax rr_4782a0Esr 1(1, DELssatiiiireriwCerztassPAra
4VFwORMAT1ON FOR APPl1CAj1G L ` a i'
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Sigantwo of ApOcanc Pboi►e:
away
06/08/01 08:53 FAX 206 467 8584 MED DENT BLDG Z 006/008
Demo Pc 547.00
DEMOLITION PERMIOAPPLICATION Cash Baal soosao
CITY OF FEDERAL WAY
(Person paying Bond) -
BUILDING DIVISION
33530 Fust Way South
-
Fcderal Way,WA 98003
(253) 661-4000-Fit(253) 661-4129
JUL Q9 Ali
DESCRIPTION OF WORK BUILDING D
PRIOR TO APPLICATION
NOTA I understand that the following ualiries shell be disconnected and service sperfarmed. if applicable,prior to issuance of the demolition perrniL
At!items are to be signed by the respective agency.
1. AseEsros REMOVAL 6. GARBAGE
uilding Official)
2. ELEcTRIC1 'Y 7. SEPTIC TANK PUME AND wt-rel C:Rus &D acCK CR
REMGYc1VOR 5EWIM.LINE PiJGGEL AT PROPERTY LINE.(It spcction
required prior to backfiBing)-
(Puget Power)
3_ TELEPFIC 111 8. WATT L*ts CLT AT PRCP2-TY LTK (well capped)_Ins-Peed=required
( /1 r� prior to backalling.
4. vas 9. ALL utzE.4GIi OCr 4D TANKS PUIa.12ED ANC nuovED UNtSfR TEM
nuA.3:nvegr PmFaar PRIOR IO EXCAVATION.
(Washington Natural esas)
5. WAx -DtsCorir cT REQUEST 10_ Dk.arQverrr Um=CHARGES PAD;
INFORMATION FOR APPUCATIO`
Jog RFSS ( �- -�"i C �. 1 C\\AL111-LI ' �. • 1,
ADD
LEGAL DF.-s=rrON
TAXPAs.CEtNo (-)' ._ !` '24 ~c . (Attachiflengthy.)
OwNER IL Ilk. AlI.iF1e t
ADDRESS
CoNTRACTOR . C
ADDRESS -
CONTRACTOR'S LICENSE
-
(Cupy K5-d)
EXPPII AT:ON DATE
Signature of Applicant Phone
De40t311vPP
z.Eveomvi-rn
06/08/01 08:53 FAX 206 78584 MED DENT BLDG 410
X007/008
.
SC.-0-kt --- F iyi.-_-__
... SHAVE UTILITY DIS
..�� �,: �.:�:� LAKETRICTorr
HAVEN
P.O.Box 4249 • y,V1 , i•
,14
31627-1st Avenue South • Federal Way PT.9806,1
1, ` � Seattle: 941-1516 • Tacoma;927-2922 • Fax:839-9311
T�L1 DIST '
May 16 , 2001
Date
T : Lakehaven Utility District
P. 0. Box 4249
Federal Way, W.A. 98063
R : Service No. 222-03
Water Route No. la
Meter No. 995311011
I would like to have the meter removed from the following address :
31629 Pacific Highway South
Federal Wa WA 98033 _
tt is my understanding that the District shall cha wg ick hose
se
customers requesting reconnection. of the water meter,
giscornected at the request of the customer, a sum of the current
District Resolution charges pertaining to meter reconnection.
Owner Signature
- i - 0 ' .._Let a7~.4 e_ ECio"
P dne
it.I
.a e
Tam Jovanch Dick May er Donald L.P.Miller Ed Stewart Beverly J.Twedc
Coa mmi5sio er Commissioner Commissioner Comuussionrr Comrriisioner
06/08/01viry 08:53 FAX 206 7 8584 MED DENT BLDG • 21008/008
S Com-
LAKEHAVEN UTILITY. DISTRICT
Vi
'1111111
4��" - _. � sWashington 98063
r`-. 31627-1st Avenue South • P.O.Box 4249 • Federal Way,
`• S1 Seattle:941-1516 • Tacoma: 927-2922 • Fax: 839-9310
b � , �15TWel
RECEIVED
JUL 0 9 2001
May 16, 2001 CITY OF BUILDINGDEPT. AY
H-rsch Properties
A tn: Jennifer
599 Olive Way #1062
S-attle WA 98101
R- : #222 -03
D-er Jennifer:
Please sign the enclosed meter removal form and return to our
o fice .
=ter charges will be discontinued at the time the meter is
r-moved.
. ank you.
S ' ncerely,
age'. ,00//4/c.:ZA2/•
tirle• Hilton
-nager Customer Services Dept
-'I /skt
cicosure
Donald L.P.Miller Ed Stewart Beverly),TwedC
Tom Jovano ich Dick Mayer Commissioner
er Commissioner
Commissioner Commissioner
FROM.. SD_ DEACON ,a4.2,5,,-4 5r,e1..-481of 0,04 _ (1 � l'211U((F.RpI)L6." 2'L0G1 441/ST.D1 3E:4gG1p/N . 4 2 6:3.:21/50:0 2_P.,0_02•
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BUILDING DEPT' • '� ''
, : ; ' • -: tn ar sVs�u�ent Sw'z-15C. '•
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: Yt+ Suite D..9 " :'
• �;;WA Oto•
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' Regaging your inquiry a6ant trn 'rags c 'gift Sai 0 }
911713 d aea�gc `'( T611.®t tht Y e wash ate , . .
sato Seo folic' . .
•
' s•indicate,that on: 1304.0►2,3,,'� �,• Eavkoeoae itla Barite, • 5 •
* IUt! #Te n,ng lig ailhs the ttipia crone it With a r3ea
viatg so Ali raebv ut wench os and vivid of in acontsi c
?P1ioa�itpe'an�d federal rbgtiI�ths
Sgrout to fill B to the tJST wes per,
� draaant i�rriiar use. Th• e v line s°Fes'
Eo n�•Are ate '.wa'°,a,UST arm'4 p got-ltrlo m than•l Ov ' •• .
r o raa that it•b'e.pern��y cloud i as z ace
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W,Rc liT3-3So- 90 tc•d+ct�rrdrie aJ�hied is accordance ash
rl� cf C�isciat rte Sc of ajpy j�, e'in�It the�35T�A •PIeale'oo�lact .
° a rraaoants
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iso rel I �`las.. •
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