97-102616 974oa6 / b
CITY OF FEDERAL WAY PERMIT NO: BL-D97-0426
33530 First Way South J.(C. I, ;IM:')JE: POM; ' 31x,q,;M!„,,.IiP'qPr,.i „I@. ..P,,, ISSUED: 08/21/97
Federal Way, WA 98003 Building Inspection Requests 2.53-661-4140 BY : FC
253-661-4000 EXPIRES: 02/17/98
ADDRESS: 33120 47TH AVE SW
NO. : 189890-0090
PROJECT DESCRIPTION:NSF -INCLUDING PLUMBING AND MECHANICAL
BASIC # 97-1007-V94 CAPRI2
F. OWNER _. ___. y CONTRACTOR --•-- =___.__.... -_-_ LENDER -----__ .
4 LEBARON HOMES INC ? LEBARON HOMES INC ' CONTINENTAL MORTGAGE CO `
25710 212TH AVE SE 1 25710 212TH AVE SE 11555 SE 8TH ST., #110 i
0 MAPLE VALLEY WA 98038 s MAPLE VALLEY WA 98038 BELLEVUE WA 98004I
i
425-432-9124 t 432-9124 '
LEBARHI099LZ i
t:t CONTRACTORS, PLEASE USE LOCATION CODE 1132 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE = 8.2% *t*
BLD?:X MEC?:X PLM?:X FLR--EXIST--PROP--- DWELLING UNITS: 1 COMP PLAN 'UREA FEES:
TYPE OF WORK:NEW USE:RES 1ST.: 0: 1077:sf STORIES • 2 I REQUIRED PARKING..: 2 SPRINKLERS/ I PLAN CHECK FEE $ 100.00
CENSUS CATEGORY •101 2ND.: 0: 886:sf HEIGHT • 31.00 ft HAZARD CLASS . i PUB WKS PLCK(SF)..93 $ 80.00
OCCUPANCY GROUP 3RD,: 0: 0:sf VALUATION I REQUIRED SETBACKS FIRE FLOW • 0 gpm BUILDING PERMIT....* $ 800.50
:R3 :U1 :? :? OTHR: 0: 0:sf EXIST..$: 0 FRONT • 20.00 ft SBCC SURCHARGE * $ 4.50
TYPE OF CONSTRUCTION BSMT: 0: 0:sf PROP...$: 145155 SIDE 5.00 ft WATER SERVICE..:FED Mechanical Permit* $ 54.00
:5N :5N :? :? DECK: 0: 0:sf REAR • 5.00:ft SEWER SERVICE..:FED SCH IMPACT (SFR)NEW $ 2372.00
OCCUPANT LOAD GAR.: 0: 614:sf RECEIVED.:07/17/97 PLUMBING FIXT....93* $ 91.00
: 7: 0: 0: 0: TOIL: 0: 2577:sf i IMPERV SURFACE: 2271 sf SENSITIVE AREAS?.:Y
a FUEL TYPES.:GAS. GAS FANS • 4 BOILERS/COMPRESSORS WATER CLOSETS • 3 URINALS • 0 TOTAL FEES $ 3502.00
GAS PIPING.: 0 ft HOOD • 1 0-3 TON • 0 BATH TUBS • 2 DRINKING FOUNT.: 0
FURN<100K..: 1 DUCT WORK • 1 3-15 TON • 0 SHOWERS • 1 SUMPS • 0
GAS NWT • 0 WOOD STOVES...: 0 15-30 TON...: 0 LAVATORIES • 4 VAC BREAKERS...: 0
CONV BURNER: 1 FURN>100K • 0 30-50 TON...: 0 9 SINKS 1 DRAINS • 0
BBQ........: 0 MISC • 0 50+ TON • 0 DISH WASHERS • 1 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS ELEC WTR HEATERS...: 1 OTHER FIXTURES.: 0
RANGE • 1 <:10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0
GAS LOGS...: 1 > 10,000 CFM: 0 UNDERGROUND.: 0
L-- -- ::_.._ _ ------------ ' - - .-1_---._=_==__==_::__--__--_- .------ .--
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 INFO A1ION FURNISHED BY M S TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY REQUIREMENTS WILL BE MEI.
OWNER OR AGENT __ ge",-e-4 .. DATE e OZl-9,2__._
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BUILDING DIVISION
cifY•eiG RECEIVED 33530 Fust Way South
Federal Way,WA 98003
VV Ry
q��7 (206)661-4000
JULFax(206)661-4129c
GI►YOFFc& 54;c9 ?`)60 '7 -
'64/2 / Vey
APPLICATION FOR BUILDING PERMIT
PLEASE PR/NT APPLICATION # Itis 1.-Z9 -01.110
Y�l � n
Address X77 hoe, S, u) I C7chhra.tWatt / d403
Tenant (if known) Lot # Assess is Tax#
eagz,
Buildin Own is Name � ll Address
/se -bit/roil R m_es, nc, 2.5"7/0- a/.`44 e 5� Eo
City j.n�t I� State ti rp 9g' 35 Phone6/25--)5/32 ,2y—
Nature of Work I yI `e 24'12 i_L P v 1iP✓Lc e
INERNOIRMAIMINININy
Name (F,M,L) !�
Address
City State Zip
Contact P rson Da Pho a Other P one Fax
BIWi (G.CON.TAT .:...............:.:.:.:
Company Name
tt—,7yt e
Address
City State Zip
Contact Person Kel 1// r ( Phon_ Fax
J g3,5) Y3,t-Sia y yas�952-VZ
Contractor's #(card must be presented) Ls,FA9 Expirati n D Verified Yes 0 No
'+` �.:X:jC:�Y:iji:ii;:!};ijji:;ii i}i::iiiiiiiii?iiiiii::iiiii:�iiiii:{i:_:;:jj;:iiiy:_
..... •iii::-ii::'A:
Name
C r��
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION s ��
Plan en
�> Existing �q
Use
�..�if ................. :.......;,,;_::.:::::::.:. C�-�' Proposed Use /U�' LCA 14642e _
Permit includes: 1" Building ID Plumbing ❑ Mechanical ❑ Other
Type of Work: 5- Residential 'Q New 0 Remodel C1 Number of Units I 0 Deck
0 Commercial 0 Addition L1 Garage 0 Shed _❑ Other
Enter 1st Floor /( ' sq ft 2nd Floor .5-ii4.-..„ sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft _
Water Availability 0 Sewer Availability ❑ On-Site Septic System Availability 0 Project Valuation $
Zoning I Lot Size 1 y) 6.46, Existing Bldg Valuation _$
LENDERNONMEiigaiMMUMiiiiaiRM
Name ' Address
(r–L')nA—I Yl,p}A)Ira i in_tcl . C o , - - - gA 5i,. .-' //' )
City 2,1 1 e LI k e__- state zip Fit./.0 V
Cf{ANIIGAL:CONiBAor.o!
Contractor Name Address
City State Zip •
Contact Phone Fax
•
License # Expiration Date Verified 0 Yes 0 No
Contractor Name Address
City State Zip
Contact Phone Fax
License: # Expiration Date Verified 0 Yes 0 No
•..•.:::::::::::::::::>::»: ::>:::::::::::<:::<::::::*:>? :::*:::::*::::,::::::::>:_> > : iii>i�"
tUB. `: ;, ;enk: :::a:::;.>::>::;:;>:::;::::::>:
Water Closets Sinks / Urinals Lawn Sprinklers
Bathtubs Dish Washers / Drinking Fountains Other
Showers Electric Water Heaters / Sumps
Lavatories Washing ashin Machine Drains D a'
ns
`Cyte:'':'::i::::<::«::::'::::::::'::::` i�� `:' i '.i::'
L Fixttxre.Counii
s 's:8i$iiY'Miii:i::.yi: 'ci,yc ii$3is.�c is;'::: ::::::::::::::::::i i i�? i r i l l
IVIIMA A N 'gCOO `::::::::_>.<'.:_':::::>'<''> MECHANICAL EVALUATION ONLY $ 2...cce co
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 I Unit Heater 50+ Tons
Furn >100 BTUs Fans 14 Miscellaneous Fuel Tanks
Gas Hwt L, Hood 1 Boilers Above Ground
Cony Burner Duct Work 1 0-3 Tons Underground
BBQ's Wood Stoves
3-15 Tons
:.4t..1 Unt�.:�iotsllei:» ia .€`>`i22i;
DISCLAIMER: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 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 o e reliance of the city,inc ding its officers and employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: 1/111 /
�V , – ii)n <J Date: )' / (/
a<v.o 17/11/06
0 Resiential Sewer Use Certificatin
(To be completed for all new sewer connections, reconnections, ofr change of use of existing connections.
This form does not apply to repairs or replacements of existing sewer connections.)
Pursuant to King County Ordinance No. 11034, all sewer customers who establish a new service which uses metropolitan sewage
facilities after February 1, 1990 shall be subject to a capacity charge.The amount of the charge is established annually by the King
County Council but is limited by state law to$10.50 per month per residential customer or residential customer equivalent for a period
of fifteen years.The purpose of the charge is to recover costs of providing sewage treatment capacity for new sewer customers.The
charge is collected semi-annually.All future billings can be prepaid at a discounted amount.
Questions regarding the capacity charge on this form should be referred to King County Wastewater Treatment Division at 684-1740.
(Please print or type) �,r
Owner's Name / &U'O Vt e t')'LN T 0( For King County use:
(Last,First,Middle Initial) Account #
Property Tax I.D. Number ttggq/ 0-665/ c
Property Legal Address: , Monthly Rate
Subdivision Name 5to,�erock. Subdiv. # •
Six Month Due
Lot# �' Block#
Building Name
(if applicable)
Property411
��A
Street Address 33/ 7 (Jt°. S. w
City, State, Zip 1 c l WeLti, LV' T! 90-40,`3
Owner's Mailing _
Address ;257/Dal�iit&p. S. E,
(If different from
above) a-p ef /ey, //lP
3 /
Owner's Phone Number ( 1/25- ) y.3 2. fiat
Property Contact Phone Number (_
Party
to be Billed
(if different from owner)
Party's Mailing
Address
(if different from
above) "
City or Sewer District .
Date of Connection:
Side Sewer Permit #
Residential Customer
rrrPllease check appropriate box: Equivalent (RCE)
Single-family 1.0
Duplex (0.8 RCE per unit) 1.6
C 3-Plex (0.8 RCE per unit) 2.4
C 4-Plex (0.8 RCE per unit) 3.2
U 5 or more (0.64 RCE per unit)
No. of Units x 0.64 =
C Mobile home space (1.0 RCE per space) - l
No. of Spaces x 1.0 =
For condominiums, please fill out Supplemental Form A in addition to this form.
I certify that the information given is correct. I understand that the capacity charge levied will be based on this information
and any deviation will require resubmissi of corrected d f r determination of a revised capacity charge.
Signature of Owner/Representative 4*. ^ n, Date
Print Name of Owner/Representative Q./ Mt"' y' 77�5icie
1057(Rev.11/96) White-King County Yellow-Local Sewer Agency Pink-Sewer Customer
LAKEHAVEN UTILITY DISTRICT OFFICIAL USE
P.O. Box 4249 •31627-1st Avenue South• Federal Way,Washington 98063 APPL#
Seattle:941-1516 •Tacoma:927-2922• Engineering:941-2288 PERMIT#
DATE
BK#
APPLICATION FOR A SIDE SEWER PERMIT A/C#
S/N #
SITE PLAN IS REQUIRED FOR ALL APPLICATIONS
TYPE OR PRINT LEGIBLY
OWNER I t Prs_vo1l !��//
rfl eS -COL , PHONE (i/. - 3 -7/2
PROPERTY ADDRESS 331 .6 7` e, 5� u1 7 �d f�'a�� ILiety, 1011-
751(293
BILLING ADDRESS -XIS-7/ 2J - /9oe, S. E. 2pojlt) U/17 rg F
CITY STATE ZIP
LEGAL DESCRIPTION: NAME 546»P)2noOk (d Pd 54 Pei ri'{��P, LOT (7 BLK
�J / (IF APPLICABLE)
OTHER LEGAL DESCRIPTION PIS cif Pa .I O1/1*
AUTHORIZED SIDE SEWER CONTRACTOR PHONE
BLDG. IDENTIFICATION -Pesidr j D .( NO. OF UNITS PER BLDG.
WAS BLDG. PREVIOUSLY CONNECTED? YES ❑ NO I IF YES, ACCOUNT #
IS BLDG. CONNECTED TO WATER? YES ❑ NO 4 IF YES, ACCOUNT #
RESIDENTIAL )< APT/CONDO/MOBILE HOME NON-RESIDENTIAL WITHIN ULID
TYPE OF BUSINESS ( BE SPECIFIC)
SQUARE FOOTAGE OF NON-RESIDENTIAL BLDG. SQ. FT.
PROPERTY AREA SQ. FT.
(MULTIPLEX AND NON-RESIDENTIAL ONLY)
REGULATIONS AND REQUIREMENTS
ARE SET FORTH ON REVERSE SIDE OF THIS APPLICATION
t
FOR DISTRICT USE ONLY
IN LIEU OF ASSESSMENT CONNECTION FEES BILLING TYPE
RESIDENTIAL ❑
FRONT FOOTAGE $ NO. OF ERU
NON-RESIDENTIAL 0
OTHER FACILITIES $ CFC/CIC $ SIC GROUP
DEVELOPER PAYBACK $ AREA CHARGE $ APT/CONDO/MH ❑
SUB TOTAL $ BASIC PERMIT $ PUB AUTH 0
RIGHT OF WAY $ DISTRICT IN 0 OUT❑
WATER DISTRICT
PRETREATMENT $
LIFT STATION
SUB TOTAL $ ULID
TOTAL $ PLANTMENT
1/4 SEC BOOK
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