08-101649 .'
• y , t ♦ ' r'
City of Federal Way— I
Commun ty Development Services Building - Single Family Permit #: 08-101649.-00-SF
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253) 835-3050
Project Name: WHISLER 4 r
Project Address: 1003 S 316TH ST i •,, Parcel Number: 358400 0150
Project Description: ADD- Construction of a 864 sq/ft post frame garage. i plumbing or mechanical.
Owner Applicant C. ac L' Lender
JOHN M WHISLER TOWN&COUNTRY POST FRAME OWN PdUN ,l ,•' JOHN M WHISLER
1003 S 316TH CT BLDSIp ,ME B 1003 S 316TH CT
FEDERAL WAY WA 98003-5331 16521 HIGH• AY 99 ` JITE WN PF099 30/09) FEDERAL WAY WA 98003-5331
LY OOP A 981 7-3199 1 '1 I J• " SUITE C
L NWOOD WA 98037-319
Ce s -:ory• • ' Residential Garage or
Includes: #1 # I / # #4
Occupancy Class U
Construction Type Ty.e V-
>c Load:
', (sq. ft.) 7 I 0 0 0
au�` ,e I
4 1 k: s`- 7M C' r6 S - N fi
New/Additional"Sq , t 1st Floor 71 few/A i tiota Sq t',ti nd.Floor..�_,e N 'a'
New/Additional Sq.Feet-3rd Floor - 0ttpaney#1 -�a .Wit) 4 "" ?
New/Additional Sq.Feet-Basement 0 Basic Plan? No t.N
Occupancy#1 -Construction Type Type V-B New/Additional Sq.Feet-Deck 0
New/Additional Sq.Feet-Garage 0 Mechanical to be Included? No
Occupancy#1 -Class U New/Additional Sq.Feet-Other 0
Plumbing to be Included? No New/Additional Sq.Feet-Total 0
Occupancy#1 -Use Private Garage Zoning Designation R
No Fixtures Associated With This Permit!!''
ot 0 tofri la CONDITIONS:
1.PRIOR TO FINAL BUILDING INSPECTION,the existing driveway s 11 be reduced to a maximum width
of 30-feet within the required 20-foot front yard setback area(FWCC 22-1135,22-334),see approved site
plan.
PERMIT EXPIRES Sunday, November 16, 2008
Permit Issued on Tuesday, May 20, 2008
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use it a in accordanc with the laws, rules and regulations of the State of Washington
an e City of Federal Way. G
Owner or agent: Date: 1/� PO
I
L
M THIS CARD IS TO REMAIN ON-SITE ' ,
CITY OF �„9 Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 08-101649-00-SF
Owner: JOHN M WHISLER
Address: 1003 S 316TH ST
FEDERAL WAY, WA 98003-5331
This card is part of your required inspection documents. 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 SWM Precon Site Mtg(4400) 0 Initial Erosion Control(4365) ❑ Footings/Setback(4110)
Approved To be done prior to breaking ground Approved to place concrete
By Date By Date By 7/-- Date f,i
— 0 Foundation Wall(4115) ❑ Drainage/Downspout(4040) .❑ Slab/Concrete Floor(4255)
Approved to place concrete Approved to backfill Approved to place concrete
By Date By Date By Date
❑ Underfloor Framing(4285) ❑ Floor Sheathing(4105) ❑ Shear Walls (4245)
Approved to sheath floor Approved to install flooring Approved to install siding
By Date By Date By, [ L Dat /? 6
❑ Roof Sheathing(4220) ❑ Fire/Draft Stops(4095) ❑ Interim Erosion Control(4370)
Approved to install roofing Approved Approved
By Date By Date By Date
NOTE: Prior to scheduling a Framing(4120) ❑ Framing(4120) ❑ Insulation (4150)
inspection;Electrical,Plumbing&Mechanical Approved to insulate Approved to install wallboard
Rough-in and Fire/Draft Stop inspections must be
signed-off and approved. IBC 109.3.4/UBC 108.5.4
By �1..„1/4..) Dateel..iZ. O6 By Date
❑Gypsum Wallboard Nailing(4130) ❑ Final Erosion Control(4375) ❑ Final-Building(4050)
Approved to install mud&tape Approved Approved
By Date By Date By Date
• 1
For inspector reference only
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
• .
Building Division
41/46, CITY OF 33325 Eighth Avenue South
Federal VVay9 Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: /la 3 5 • 3/6 %' ST PERMIT#: o r _70
44/1 -ol/ -sF
V !"igewe--- ACCE31- I c "pi wG . 00bXS Lo ci v
S6-CU/ Oo/rr vsPbUr 7 Qvic,o/*i! 756re XAVIg c T .c' -
11/261 /....A-n/D/N/6 A-r /, 1 1Eiti,a0/z o7' 4-cc& S yAi,9•Av D6,02.1
pea- N nr/CZ3//),
V/AE SiO44-5I/.814Dc h DotvkcA 1y- ,c "7740i
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lJ izezrfru, fart '//vf 2 isii/c,o C AD Di 7 iriz
pi'/e ,
IF YOU HAVE ANY QUESTIONS CALL R0,014 ,&I42- (253) 835- Z6 z3
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
/Q/2-6f/0 e / 74c-
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page 1 of
•
' ••
Building Division
CITY OF 33325 Eighth Avenue South
Federal WayP9 063 9718
Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTIO NOTICE
ADDRESS:�J 3 S E-th
"ERMIT#: 0 —1 d �
Noie C i‘ sir o ' ior� �,�ss-1 tea t Wraps 0 re(
�-e th�+ss per dto �l % of /ahs
t P �
fj� I 1
IF YOU HAVE ANY QUESTIONS CALL !'I ) (A 'Y/ t'(253) 835- Z-1-3°1
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
S/Z4 gov
D•TE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
Building Division
CITY OF 33325 Eighth Avenue South
w.Ahhi. Federal WayP9 Box 9718
Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: p03 /- 3/(0124: 4T PERMIT#: D1?'.-/d1C,4/1 + ea -SG
01) / 0 OrM Ato A - - 1 •
IF YOU HAVE ANY QUESTIONS CALL (253) 835- 40
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
Itii(OF 10:56*
D TE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
• Building Division
CITY OF 33325 Eighth Avenue South
Federal WayP9 0639718
Federal Way,WA 98063-9718
Phone 253-835-2607
Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: t c L ` S t h 9-F PERMIT#: cf I--EA
IF YOU HAVE ANY QUESTIONS CALL (253) 835- 2 6 &_`J
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
I 1—EAS
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
Ar
MMM
Owti C 0 Suite C - 16521 Highway 99 , Lynnwood, WA 9BD37.3161
W POST FRAME BUILDINGS Everett: (425) 258-4171 Puyallup: (253) 840-9552
-�Nmw Administrative Headquarters: (425) 743-1555
em FAX: (425) 742-4378 Toll Free: 1-800-824-9552
MpPmcr Contractor's Lic. #: TOWNCPF099LT
Quality; Our Future Depends On 1;—.Z-
Tax Account t 3584000150
bite man
Please Check After Doing Site Plan: C3 Septic and drainfield (3 Lot size Draw North Arrow in Circle
N Property dimensions 0 Sewer lines El Elevation of property
0 Existing buildings 0 Setbacks of proposed & existing buildings 0 Bodies of water
[K Proposed building N Main road with name 0 Floorplan
Easements
f@ Access to proposed building 0 Slopes& Contours (5' increment
Job Name- John Whisler Job Site Address: 1003 S 316TH ST s,
Legal Description: FEDERAL WAY, WA 9800
SCALE: V= 201
LOT SIZE= 10,776 SF ( 0.25 ACRES)
EXISTING IMPERVIOUS
HOUSE = 1950 SF
DRIVEWAY = 1335 SF (PORTION TO BE REMOVED)
S� ORAGE/WOO6 SHED = 160 SF
NEW IMPERVIOUS
PROPOSED BUILDING = 864 SF (PORTION TO BE
BUILT WHERE DRIVEWAY is REMOVED)
SEWER
LINE
N
3146TH ST
48.771
I
110.871
00
M
0 M
6
0 M
i Cn zi,
RECEIVED 0 Z.. W..:
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APR 0 7 2008 -01. >
X 0 cl)
Cn M M
0 r'.
CITY OF FEDERAL WAY r— > �O
M 0
CDS 0
0
U)
Cn
71-11
DO NOT SIGN INCOMPLETE SITE PLANE
Z
Customer has verified and approved the location of the building, orientation of the building to the North, and verifies that all White ® Customer Copy White - Office Copy Yellow - Accounting
utilities are shown on this drawing in the correct location.
CUSTOMER SIGNATURE
LEAD# 67358
JD
Federal way PERMIT
COMMUNITY DEVELOPMENT SERVICES nPR o i Z' Sr< F CO ME EL PL DE EN FP
3332PEDERAAVENUE SOA 98063971 97] AppLI CATI ON
FEDERAL WAY. WA 53-8 3 -260
z5s�.45-ar07• FAX 253-835-2609
OF FEDERAL WAY
The following is required ijokbStion - an incomplete application will not be accepted. Please print legibly (in ink) or type.
ASSESSOR'S TAX/PARCEL # -23 _�t U 1.1 - U 4
LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(A aach separate page for lengthy legal description)
PROJECT INFORMATION
TYPE OF PERMIT I/ UILDING ❑ PLUMBING El MECHANICAL
/❑ `DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Pra ide gefaa d description of u)ork included on this OeEmit an&
16 U L �j d -Pm Y) erg Yam,
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR rr
V�
Np�,S DL->,
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
y-owu VmnL 1�1h� s l.e,r� (10flgte - o
MAI O{; pn � r � � � ` CI- �. 7� E-MAIL ADDRESS
��
_ Town & Country Post Frame Bldgs
n 16521 Hwy 99 Ste C
Lynnwood, WA 98037
TOWNCPF099LT
1-425-743-1555
) 6- i u ( io
'vmcANT NAME
lY.
(2)
OFFICE KIONF.
( qzS)7 3 - I s
CELL M1ONE
VAX NUMBER
(4 2S ) 7yZ - q 3-7
E-MAIL ADDRESS
xymubzarrialn f-, cz)-Y✓1
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
( -
PRIMARY PHONE
( � ) - ss'!—
EMAIL A
3h�I
D ,�,,,,
W&LI
111
NAME j
Per RCW 19.27.095:
Lender information is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES XNO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER o LAKEHAVEN
PROPOSED USE &JA[mow n4n, rw !► ►�+ G�
VALUE OF PROPOSED WORK $ DO
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES O
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) � lA s
❑ HIGHLINE 1-1PRIVATE(SEPTIC) � 10 I
CITY OF
ti. Federal Way
April 29, 2008
Ms. Rebecca Cort
Town & Country Post Frame Buildings
16521 Highway 99, Suite "C"
Lynnwood, WA 98037-3199
RE: File #08-101649-00-SF; WHISLER DETACHED GARAGE
1003 South 3161h Street, Federal Way
Dear Ms. Cort:
FILE
CITY HALL
33325 8th Avenue South
Mailing Address: PO Box 9718
Federal Way, WA 98063-9718
(253) 835-7000
www.cityoffederalway.com
On April 7, 2008, you submitted to the Department of Community Development Services drawings to
construct a detached garage addition to the existing residence at the above -referenced site. I have
completed a preliminary planning review of the submitted plans. The items listed below need to be
addressed or submitted before any further review on my part can continue.
1. Please revise the site plan to address the following and submit three sets of the plan:
a. Show extent of that portion of driveway noted to be removed as well as what will remain.
Please note that the driveway width located within the first twenty feet of the front property is
limited to a maximum width of 30 feet.
b. Depict the storage shed building called out in the lot coverage calculation.
C. Show north arrow.
2. Please revise the drawings on sheet 1 of 2 to address the following and submit two sets of the sheet.
a. Provide scaled drawings. Drawings do not meet typical architectural scale. Minimum scale
shall be'/4" = F-0".
b. Re -label the correct cardinal direction of the building orientation. Other documents provided
suggest the building is oriented other than shown on this plan sheet.
C. Show the required landing on the exterior side of the man door.
Please provide a resubmittal form (enclosed) with any submitted documentation. Please note that the
items listed above should not be viewed as a comprehensive list. Further corrections may be necessary as
a result of submitting additional information. If you have any questions contact me at 253-835-2623, or
femando.femandez@cityoffederalway.com.
Sincerely,
Fernando Fernandez
Plans Examiner/Building Inspector
enc: Resubmittal Information Form
Doc I D. 45238
PROJECT FLOQR AS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
r ; „/L
L? 0
GARAGE CARPORT ❑
NUMBER OF FLOORS
EXISTING
PEOPOSED
TOTAL
TOTAL EXI3TSYG 9F
rOr YHO 3F
L'
x'O'rAG Ni
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ —�
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING U
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (commeroia)
COMPRESSO
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUIMSING
BATHTUBS (o ntblsu,., • • , . L .
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNT
SHOWERS
WATER CLOSETS (Tone)
ELECTRIC WATER EATERS
SINKS
WASHING MACHINES
HOSE BIBBS SUMPS
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 d such claim), which may be made by any person, including the undersigned, and filed against the city, but only
where such clai rises au of the reliance of the ity, including its officers and employees, upon the accuracy of the information supplied to
the city asap of this apZlica.I! /�
SIGMA ~ DATE t/
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
EW DITION
❑ 4TERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL- NLY?
❑ YES
NO
BASIC PLAN? ❑ YES
O
ZONING DESIGNATION
Win
CHANGE OF USE? ❑ YES
I O
NEW ADDRESS REQUIREDIA
❑ YES
O
UP/SEPA/SU? ❑ YES
NO
PLATTED LOT?
YES
❑ NO
DEMO PERMIT REQUIRED? ❑ YES
O
Bulletin #100 - January 1, 2008 Page 2 of 4 k\Handouts\Permit Application
R E C E I V TMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
PO Box 9718
CITY OF Federal Way WA 98063-9718
Fe d e ra I WaY,..,,-Y
APR 0 7 2008 253-835-2607; Fax 253-835-2609
OF FEDERAL WAY www.cityoffederalway.corn
CDS
HAZARDOUS MATERIALS INVENTORY STATEMENT
CRITICAL AQUIFER RECHARGE AND WELLHEAD
PROTECTION AREAS
I. WHY SHOULD THIS INVENTORY STATEMENT BE FILLED OUT?
Critical Aquifer Recharge (CARAs) and Wellhead Protection Areas (WHPAs) are considered
"critical areas" pursuant to Federal Way City Code (FWCC), Chapter 18, "Environmental
Protection." This inventory statement must be filled out by the applicant or agent for any proposed
activity listed in Section II of this handout, and which are located within Wellhead Capture Zones 1,
5, and 10 as shown on the Critical Aquifer Recharge and Wellhead Protection Areas Maps. Please
refer to the handout on Critical Aquifer Recharge and Wellhead Protection Areas for a description of
the review process.
II. ACTIVITIES GOVERNED BY CARA AND WHPA REGULATIONS
The inventory statement must be filled out for the following activities:
■ Construction of any residential structure, including single-family development
• Construction of any barn or other agricultural structure
■ Construction of any office, school, commercial, recreational, service, or storage building
■ Construction of a parking lot of any size
■ Other minor new construction (see WAC 197-11-800[2])
Additions or modifications to or replacement of any building or facility (does not include
tenant improvements)
• Demolition of any structure
• Any landfill or excavation
• Installation of underground tanks
• Any division of land, including short plats
• Change of use, which involves repair, remodeling, and maintenance activities
• Dredging
■ Reconstruction/maintenance of groins and similar shoreline protection structures
• Replacement of utility cables that must be buried under the surface of the bedlands
• Repair/rebuilding of major dams, dikes, and reservoirs
• Installation or construction of any utility, except for on -going operation and maintenance
activities of public wells by public water providers
• Personal wireless service facilities
Project Name i S <<� _ Applicant i
Project Location1003 3 Ito V-- Tracking No. � 0& /o/ 6 �V
III. TYPES AND QUANTITIES OF HAZARDOUS MATERIALS
Please provide the approximate quantity of the types of hazardous materials or deleterious substances
that will be stored, handled, treated, used, produced, recycled, or disposed of in connection with the
proposed activity. If no hazardous materials will be involved, please proceed to Section IV.
MATERIAL
LIQUID (gallons),
SOLID (pounds)
(1) Acid or basic solutions or solids
(2) Antifreeze or coolants
(3) Bleaches, peroxides, detergents, surfactants,
disinfectants, bactericides, algaecides
(4) Brake, transmission, hydraulic fluids
(5) Brine solutions
(6) Corrosion or rust prevention solutions
(7) Cutting fluids
(8) Deicing materials
(9) Dry cleaning or cleaning solvents
(10) Electroplating or metal finishing solutions
(11) Engraving or etching solutions
(12) Explosives
(13) Fertilizers
(14) Food or animal processing wastes
(15) Formaldehyde
(16) Fuels, additives, oils, greases
(17) Glues, adhesives, or resins
L
(18) Inks, printing, or photocopying chemicals
(19) Laboratory chemicals, reagents or standards
(20) Medical, hospital, pharmaceutical, dental, or
veterinary fluids or wastes
(21) Metals (hazardous e.g. arsenic, copper,
chromium, lead mercury,silver, etc.
(22) Paints, pigments, dyes, stains, varnish, sealers.
(23) Pesticides, herbicides or poisons
(24) Plastic resins, plasticizers, or catalysts
(25) Photo development chemicals
(26) Radioactive sources
(27) Refrigerants, cooling water (contact)
(28) Sludges, still bottoms
(29) Solvents, thinners, paint removers or strippers
(30) Tanning (leather) chemicals
(31) Transformer, capacitor oils/fluids, PCB's
(32) Waste oil
(33) Wood preservatives
(34) List OTHER hazardous materials or deleterious
substances on a separate sheet.
Bulletin #056 — November 24, 2004 Page 2 of 3 k:\Handouts\Hazardous Materials Inventory Statement
Project Name W S I e t— Applicant otti.Jr.] c ��•
Project Location QQ 3 S , 3 5 T— Tracking No. o — Ul -OZD
IV. FURTHER INFORMATION
Provide the approximate quantity of fill and source of fill to be imported to the site.
Approximate Quantity of Imported Fill Source of Fill
Check box # 1 if you do not plan to store, handle, treat, use, produce, recycle, or dispose of any of the
types and quantities of hazardous material or deleterious substance listed in Section III. Check box(s) #2
through #5 (and fill in appropriate blanks) of the below table if they apply to your facility or activity.
#1
The proposed development will not store, handle, treat, use, produce, recycle, or dispose of any of
the types and quantities of hazardous materials or deleterious substances listed above.
#2 [ ]
Above ground storage tanks, having a capacity of gallons will be installed.
#3 [ ]
Construction vehicles will be refueled on site.
Storage within wholesale and retail facilities of hazardous materials, or other deleterious
#4 [ ]
substances, will be for sale in original containers with a capacity of _ gallons liquid or
_pounds solid.
The presence of chemical substances on this parcel is/will be for "temporary" non -routine
#5 [ ]
maintenance or repair of the facility (such as paints and paint thinners) and are in individual
containers with a capacity of _ gallons liquid or _mounds solid.
Check any of the following items that currently exist or are proposed in connection with the
development of the site.
# 1 [ ]
Stormwater infiltration system (e.g., french drain, dry well, stormwater swale, etc.)
#2 [ ]
Hydraulic lifts or elevator, chemical systems, or other machinery that uses hazardous materials
#3 [ ]
Cathodic protection wells
#4 [ ]
Water wells, monitoring wells, resource protection wells, piezometers
#5 [ ]
Leak detection devices, training for employees for use of hazardous materials, self-contained
machinery,etc.
SIGNATURE L
Signature
Print Name
7 /a 9`�,
If you have any questions about filling out this application form, please call the Department of Community
Development Services at 253-835-26OZ Please be advised that an application for a development permit
lacking the required information will not be accepted.
Bulletin #056 —November 24, 2004 Page 3 of 3 k:\Handouts\Hazardous Materials Inventory Statement