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93-101666 CITY OF FEDERAL WAY BUILDING PERMITPERMIT NO.: BLD93-0730 33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 07/16/93 Federal Way, WA 98003 BY: FC 661-4000 SITE ADDRESS: 31227 9TH AVE S PARCEL NO.: 858220-0100 PROJECT DESCRIPTION: CONVERTING GARAGE INTO LIVING AREA = OWNER - CONTRACTOR LENDER - DANIEL GETZLAFF *OWNER IS CONTRACTOR* 31227 9TH AVE S FEDERAL WAY WA 98003 7886 *OWNER* — 1 BLD?:X MEC?:X PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 1 COMP PLAN •SR FEES: TYPE OF WORK:ADD USE:RES 1ST.: 1248: 187:sf STORIES • 1 REQUIRED PARKING..: 2 SPRINKLERS? -? PLAN CHECK DEPOSIT.* $ 93.60 CENSUS CATEGORY •434 2ND.: 0: O:sf HEIGHT • 0.00 ft HAZARD CLASS •? FINAL PLAN CHECK...* $ 0.00 OCCUPANCY GROUP 3RD.: 0: 0:sf VALUATION REQUIRED SETBACKS FIRE FLOW 0 gpm BUILDING PERMIT....* $ 144.00 :2.3 OTHR: 0: 0:sf EXIST..$: 54500 FRONT - 20.00 ft SBCC SURCHARGE * $ 4.50 TYPE OF CONSTRUCTION BSMT: 0: 0:sf PROP. .5- 12177 SIDE - 5.00 ft WATER SERVICE..:FED MEC APPLIANCE FEES.* $ 6.50 :5N DECK: 0: O:sf REAR - 5.00:ft SEWER SERVICE..:FED OCCUPANT LOAD GAR.: 0: 0:sf RECEIVED.:07/06/93 . 0: 0: 0: 0: TOTL: 1248: 187:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:N F'JEL TYPES.:? ? FANS - 0 BOILERS/COMPRESSORS WATER CLOSETS - 0 URINALS • 0 TOTAL FEES $ 248.60 GAS PIPING.: 0 ft HOOD - 0 0-3 HP - 0 BATH TUBS - 0 DRINKING FOUNT.: 0 FURN<100K..: 0 DUCT WORK - 1 3-15 HP - 0 SHOWERS - 0 SUMPS • 0 GAS HWT • 0 WOOD STOVES...: 0 15-30 HP - 0 LAVATORIES • 0 VAC BREAKERS...: 0 CONV BURNER: 0 FURN>100K - 0 30-50 HP - 0 SINKS - 0 DRAINS • 0 BBQ • 0 MISC - 0 5+ HP - 0 DISH WASHERS • 0 LAWN SPRINKLERS: 0 GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0 RANGE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0 CarGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE. I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET. OWNER OR AGENT Z _, / I �i ��% DATE 2/V913 bld_prmt 10/23/92 � ��, CITY F FEDERAL WAY 335300Firstt Way South BU I LD I NG P PERISSUED: 07/116/9330 Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC 661-4000 EXPIRES: 01/12/94 ** REVISED PERMIT ** ADDRESS:31227 9TH AVE S NO. : 858220-0100 PROJECT DESCRIPTION:CONVERTING GARAGE INTO LIVING AREA OWNER — c CONTRACTOR a LENDER 4111 DANIEL GETZLAFF 31221 9TH AVE S FEDERAL WAY WA 98003 839-7886 'OWNER' BLD?:X MEC?:X PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 1 COMP PLAN .SR FEES: TYPE OF WORK:ADD USE:RES 1ST.: 1248: 181:sf STORIES • 1 REQUIRED PARKING..: 2 SPRINKLERS? .? PLAN CHECK DEPOSIT.' $ 93.60 CENSUS CATEGORY •434 2ND.: 0: 0:sf HEIGHT • 0.00 ft HAZARD CLASS .? FINAL PLAN CHECK...= f 0.00 OCCUPANCY GROUP 3RD.: 0: O:sf VALUATION REQUIRED SETBACKS FIRE FLOW 0 gpu BUILDING PERMIT....; i 144.00 :R3 : OTHR: 0: O:sf EXIST..$: 54500 FRONT . 20.00 ft SBCC SURCHARGE $ $ 4.50 TYPE OF CONSTRUCTION BSMT: 0: 0:sf PROP...$: 12111 SIDE • 5.00 ft WATER SERVICE..:FED MEC APPLIANCE FEES.' $ 6.50 :5N : DECK: 0: O:sf REAR • 5.00:ft SEWER SERVICE..:FED BUILDING PERMIT....' $ 12.00 OCCUPANT LOAD GAR.: 0: O:sf RECEIVED.:01/06/93 . 0: 0: 0: 0: TOIL: 1248: 181:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:N FUEL TYPES.:? ? FANS • 0 BOILERS/COMPRESSORS WATER CLOSETS • 0 URINALS • 0 TOTAL FEES f 320.60 III GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 BATH TUBS • 0 DRINKING FOUNT.: 0 FURN<IOOK..: 0 DUCT WORK . 1 3-15 HP • 0 SHOWERS • 0 SUMPS • 0 GAS HIT • 0 WOOD STOVES...: 0 15-30 HP • 0 LAVATORIES • 0 VAC BREAKERS...: 0 CONY BURNER: 0 FURN>100K • 0 30-50 HP • 0 SINKS • 0 DRAINS • 0 BBQ • 0 MISC • 0 5+ HP • 0 DISH WASHERS • 0 LAWN SPRINKLERS: 0 GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS ELEC ITR HEATERS...: 0 OTHER FIXTURES.: 0 RANGE • 0 (_10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR QUILTS...: 0 GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE. I CERTIFY THAT THE INFORMATION FURNI ED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FERERAL WAY REQUIREMENTS WILL BE MET. OWNER OR AGENT , J c_ _ '1L�_ /, �__� DATE __ rI `d 4---- FILE COPY AdOO 0131d hi,-z/-6 31Ya /j .-- �_ __ DOH HO d3HMD '13N 15 111* SIN3N3dIA03H AY* 1Y03031 JO A113 319Y3IlddY 3H1 ONY 39011110N/ AN JO 1539 3141 01 133HHO3 ONY 30111 SI 3N A9 03 NUJ NOIIYNIOJNI 3H1 IYH1 AJI1H33 I '33NYASSI JO 31Y0 H31JY HY3A 3140 HIMSIINH3d 9NIOVH9 ONY 1Y11N3OIS3H ''0318Y15 SI AHO* ON j1 33NYASSI 0310 SAYO Oat 30IdX3 SIINH3d -- _�.�.��+.rwe�s..ar+.....r+-:.._._.�.v., -_,__ y._�...r.w ,,,.+.. -.,... -..-...,._:+:.-.�^3:-'osr-..uesa.m•r- ,wee re -s+•+wn+,- ... - - _ _...__.._�.__. _....._.-... o :'ONAOH9H30MA 0 41j3 000'01 < 0 "'5901 SYS 0 :—S11100•S111RO HHS* NOV1 0 :011006 3A09Y 0 :NJ3 000'O1:> 0 • 39NVH 0 :'S38111XIj 1131110 0 :"'SH31Y3H 111* 3313 ----SANY1 130j 51INA 9NI1ONYH HIV 0 :"1113AH0 SY9 0 :SH311111HdS N*Y1 0 • SH3HSY* HS10 0 • dH +S 0 • 351$ 0 • 098 0 • SNIYHO 0 • DOHS 0 • dH 0S-OE 0 • A00t<NHAi 0 :H3NdfH ANN 0 :—S03”306'SH3AY3Ha 3YA 0 • 5311101YAY1 0 • dH OE-SI 0 :"13AOIS 000* 0 • 1*H SY9 0 • SdNAS 0 • SH3*OHS 0 , dH S1-E I • AHO* 13110 0 :"AOOt>NHAJ 0 :'11100j 9NI1N180 0 • 5901 HIV9 0 - dH E-O 0 • 000H II 0 :'9Nldld SY9 09'0dt 1 5333 1Y101 0 : S1YNIHf 0 : 5135013 1131YM S8OSS3Hd$03/Sd311O9 0 Milli . 4:'S3dA1 13AJ ___-.-_ _�__._..__._.._ _.___.A._ T._.....__.--_. . --•Win--•--•---- - 4 N:'ISY301 3AI115N3S is 0 :33VjHAS AH3d$I h :0 :0 :0 :0 s,X6190 k "�1!1:,4%;• ' :i.:;',,''-'':1'''\., OYO1 1NYd0330 00'Zi 3 t""lINH3d 9N101I09 03j:"331Ad3S d3*3S t1:00'S . 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SH II --dO0d--1 =-H1j :4N1d X433$ X:1019 1------------_._---- ,- . _ --_s .------.. _ _....,... __.••-—,,.--.',..-- ---,---.*.^-'-* _L _ 9115L-sca £0056 Y* AV* 1Y113031S 3AY Hifi LZZIE JIY11139 13INY0 --_ Haim _ -_ ._ �—�� H013YHIN03 —�—�.- -- _ . �_ -A HMO Y3HY 9NIAl1 01141 19YHV9 9NIIH3AN03:NOIldIHOS 30 103rOild X 0010—OZZ8S8 : 'ON b -2l-/y _ 3 S 3AV H16 LZZ t£:SS3800V *+s i1V64did {33SIA38 •s S38IdX3 OOOV- 199 03 :.18 Obtp—t99 sl.sanbaa uoLlaadsul 6u&pljn8 £0086 VM `ARM 1euapa3 SSI O£LO—£6019 :ON�1I1483d ,1., 1 W (j DWG -line 4 DAVM 1b133033 `30 ALIO 1 • • SETBACKS & FOOTINGS Date By FOUNDATION WALLS Date By PLUMBING GROUNDWORK Date By UNDERFLOOR FRAMING Date By r-SHEAR WALLS Date By PLUMBING ROUGH-IN Date By GAS PIPING Date By MECHANICAL ROUGH-IN! Date By MECHANICAL (OTHER) Date By FRAMING rr � Date l r l � cBY INSULATION Date f ?"--(;1 '5-By X. GWB - 1ST LAYER Date By GWB - 2ND LAYER Date By SUSPENDED CEILING Date By PLANNING FINAL Date By ENGINEERING FINAL Date By FIRE FINAL Date By BUILDING FINAL Date By OTHER Date By OTHER Date By CD01 93 CITY OF FEDERAL WAY BUILDING PERMIT PERMIT NO.: ELD93 -0730 33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 07/16/93 Federal Way, WA 98003 BY: PC 661-1000 SITE ADDRESS: 31227 9TH AVE S PARCEL NO.: 858220®0100 PROJECT DESCRIPTION: CONVERTING GARAGE INTO LIVING AREA OWNER CONTRACTOR LENDER DANIEL GETZLAFF *OWNER IS CONTRACTOR* 31227 9TH AVE S FEDERAL WAY WA 98003 839-7886 AO *OWNER* BLD?:X MEC?:X PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 1 COMP PLAN -SR FEES: TYPE OF WORK:ADD USE:RES 1ST.: 1248: 187:sf STORIES • 1 REQUIRED PARKING..: 2 SPRINKLERS' •' PLAN CHECK DEPOSIT.* $ 93.60 CENSUS CATEGORY •434 2ND.: 0: 0:sf HEIGHT • 0.00 ft HAZARD CLASS .' FINAL PLAN CHECK...* $ 0.00 OCCUPANCY GROUP 3RD.: 0: 0:sf VALUATION REQUIRED SETBACKS FIRE FLOW • 0 gpm BUILDING PERMIT....* $ 144.00 :R3 OTHR: 0: 0:sf EXIST..$: 54500 FRONT • 20.00 ft SBCC SURCHARGE * $ 4.50 TYPE OF CONSTRUCTION BSMT: 0: 0:sf PROP...$: 12177 SIDE • 5.00 ft WATER SERVICE..:FED MEC APPLIANCE FEES * $ 6.50 :5N DECK: 0: 0:sf REAR • 5.00:ft SEWER SERVICE..:FED OCCUPANT LOAD GAR.: 0: 0:sf RECEIVED.:07/06/93 0: 0: 0: 0: TOTL: 1248: 187:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:N FUEL TYPES.:? ? FANS • 0 BOILERS/COMPRESSORS WATER CLOSETS • 0 URINALS • 0 TOTAL FEES $ 248.60 GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 BATH TUBS • 0 DRINKING FOUNT.: 0 FURN<100K..: 0 DUCT WORK • 1 3-15 HP • 0 SHOWERS • 0 SUMPS • 0 GAS HWT • 0 WOOD STOVES...: 0 15-30 HP • 0 LAVATORIES • 0 VAC BREAKERS...: 0 CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0 SINKS • 0 DRAINS • 0 BBQ • 0 MISC • 0 5+ HP • 0 DISH WASHERS • 0 LAWN SPRINKLERS: 0 GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0 RANGE • 0 <=10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0 GOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0 ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE. I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MET. L.774 , , �� OWNER OR AGENT roirc!' DATE 00 0 3 btd_prmt 10/23/92 / , J 0jCIT'f OF* � - ED 33530 First Way Citizen Action Request Federal Way, WA 98003 (206) 661-4000 FILE N O: DATE RECEIVED: REQUEST TAKEN BY: IN PERSON PHONE MAIL FORWARD To: POLICE FIRE PUBLIC WORKS PLANNING BUILDING PARKS OTHER ISPEciFv) Location of Occurrence: TAX LoT No: KROLL PG. 1 QTR SEC. NAME OF PROPERTY OWNER OR RESPONSIBLE PARTY: ADDRESS: CITY: STATE: ZIP: PHONE: HM WK NATURE OF REQUEST: How long has this been happening? What time of day does the problem occur? Have you or your neighbors spoken to the person responsible? PERSON REQUESTING ACTION: ADDRESS: CITY: STATE: ZIP: PHONE: HM WK RESIDENT OF FEDERAL WAY WORK IN FEDERAL WAY VISITING CITY EMPLOYEE I understand that this file may constitute a public record, subject to public review. SIGNATURE: DATE: ACTIVITY SUMMARY: CV &r I/JJ6! C 2 `/ 1 '/5 '' 6% 4/ G c�Jopy.ed4,1 , -&--i4tpa ,- 694Id, - Clivl ke —� 7-6-1.- ? a.- SIGNED DATE RESOLVED: REQUEST.FRM REVISED 118/91 I City of Federal Way APPLICATION FOR BUILDING PERMIT PLEASE PRINT APPLICATION #: to 73 -073<' SITE LOCATION Address 3 Z Z 7 _ MA)TH Av t LAT tl Tenant (if known) Lot # Assessor's Tax # ?A/—'+Ct. /"). E MAI 1LYA) K. GETzLArr /r) CVOC Building Owner Name Address SAME 3i Z Az 7 N,,JTN Ay. 5( . City f el?ERA L i.✓A Ai State IA/A Zip 980&3 !Phone ZO Nature of Work skA REMOfE APPLICANT Name (F,M,L) I/RNIEL iL4AAN GETZt�1G� Address 3fZZ7 - - ,I/A/T i Av. IState y A Zip t9 tJ( City FE17E'/Z��l L.' .� Contact Person Day Phone Other Phone Fax l> - "' MA-/Z//-q^" 2-06 - b39-78f3G tir/,4 to,/y BUILDING CONTRACTOR Company Name GV ' /kJ ECS Address City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified ❑ Yes O No ARCHITECT Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION / T E/e-AA LANE. AGC C',:D)A TO Tt#i�" PLAT INE/2E 0/t RE CcIADGI> I .Lit Ei5 OF PLAT-.5, I'sAc,t 9p/ /N icii Le�J.vT`' Lt.A . Please Complete Reverse Side CD0492(Rev 4/931 • • City of Federal Way F-r'e'f_ \\> �' APPLICATION FOR BUILDING PERMIT PLEASE PRINT APPLICATION #: 13(,Oct 3—07 3 0 SITE LOCATION Address ?j 1227 -- MNTN Av. SOvT i Tenant (if known) Lot # DANIEL M. MARILYN Assessor's Tax # ARIL.YN k. G ErZ(..,9FF $SF322O-0100 Building Owner Name Address SAME 31227 --NINTH AVE. So. City FEDt,KAL NA/A-Y State WA Zip 9 S003 Phone Z.oG -8 39_7886 Nature of WorkI'�AKIIJG C/-}ANDES APPLICANT Name (F,M,L) DANIEL. MARK C-7E7.ZI.AFF Address • 31227 NINTH Av. So City F-61)67e.4 LJ,I4 4 State INA Zip 9 g o 0 3 Contact Person Day Phone Other Phone Fax DprJ oR MAkiLYN z.,4.-439-7$430, nl/A N2A BUILDING CONTRACTOR Company Name OwN8A Address • City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No ARCHITECT. :: Name O wNE2 Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION LOT !O, -r R.2A LANE, Ac.co,eD/n/6 rc 7-7-4E PLAT TNEREQF RECORDED int VOLUME 85 OF PLATS/ PAGE 90, /n/ /'WING Covnr7`f/ In/A Please Complete Reverse Side 000492(Rev 4 93 • STRUCTURE Existing Use SfNGLE FAMIL'1 QESfDEA/G.E Proposed Use SAME Permit includes: Z Building ❑ Plumbing ❑ Mechanical ❑ Other Type of Work: ❑ Residential ❑ New ®Remodel ❑ Number of Units_ ❑ Deck ❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other Enter 1st Floor j2-148 sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area 1 Z4j€3 sq ft Area Basement sq ft Decks sq ft Garage z g S sq ft Proposed Total Area 13 L{y sq ft Water Availability ® Sewer Availability On-Site Septic System Availability ❑ Project Valuation $ 700C° Zoning Rs-7. a Lot Size 59Ca0 Sq. FT, Existing Bldg Valuation $93 20o°9 J LENDER Name N A Address City State Zip MECHANICAL CONTRACTOR Contractor Name Address Iv/A City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PLUMBING CONTRACTOR Contractor Name Address N/q City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PLUMBING FIXTURE COUNT Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total Fixture Count MECHANICAL UNIT COUNT Fuel Type (electric/other) Gas 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 Total Unit Count DISCLAIMER: I certify under penalty of perjury that the information furnished by me le true and correct to the best of my knowledge and further that I am authorized by the owns 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 City, including its officers and employees,upon the accuracy of the information supplied to the City as a pert of the application. Owner/Agent: / —111/- � G 3C) _ /� +� /%- Date: y r -_ SEAb-KING COUi1TY DEPARTMENT OF PUBL I C HEA, ENVIRONMENTAL HEALTH SERVICES Total Fee: X75.00 APPLICATION FOR HEALTH DEPARTMENT 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.). Properties in incorporated cities apply to local building departments. PROPERTY INFORMATION I ! House/structure is served by an on-site sewage (septic) system Distance to the nearest public sewer eC)' - kt5LpFWcE A LYZEAp Y GcNAlec-rEp To Pvt3uc SEIVEW Address of property 312.27 --2\/,NTH A0/. So.) _F-EA+✓RAL- Int4q, iiJ4 ' so- 3 Parcel Number (Tax lot Account #) 4g5-82.2-0 —010C)—0 Applicant's name \ t.J1 E(, /"1 . GETzc_.¢G/ Day Phone 839- 7 E3E6 Applicant's mailing address Owner's name Day Phone Age of house 2 Syr, Number of existing bedrooms 3 Existing square footage of house IZ y$ Are additional bedrooms being constructed or created? N o 72 Evis/o)./ Z Description of proposed changes/remodeling (attach plot plans, showing existing structure, remodeling and septic system): GoNveRSro,J of ATTAU-IEA GAR96,6 /nlTO PAxrreg New square footage after construction / 3Lig SEWAGE SYSTEM INFOR94ATIOH • Approximate dates septic tank was pumped (attached receipts) /1/4.144 Additions or major landscape changes since house was constructed (examples: add family room, bed- rooms, garage, patio, deck, pool, etc.; major fills or excavations done in landscaping): N/4 Additions or repairs to sewage system (give date and describe briefly) /A Other information which would be helpful in evaluating the sewage system (ie. drainfield easements, • covenants, etc.): WATER SUPPLY INFORMATION Public system (2 or more connections) n Private (well, spring, etc.) Attach copies of well log, well Name of Public Supply_ I=o5T,F-RAt, W,44 (AJA-Tee. f SE 'E . covenants, chemical/bacteriological sample reports FOR HEALTH DEPARTMENT USE ONLY Date Received n APPROVED BY: Date 1 DISAPPROVED BY: Date Comments/Conditions: Any person aggrieved by any decision or final order of the Health Officer may make written application for appeal to the King County Board of Sewage Review if done so within 60 days of the above decision. /hd/)wago/forme/form37/6-3-91 • APPLICANT The following must be included with your application : Provide an accurate route map and directions for locating the property, including color of building (house, garage , etc. ) Three copies of a completed Health Department Application Form Application review fee $75.00. Three copies of your building permit application (i.e. from the City Building or Land Use department) Three copies of the scaled plot plan of the project. Show location of on-site sewage system, well , spring, easements, etc. Copies of easements, covenants or other records pertaining to sewage disposal or water supply