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97-102636 • c:-.."•F . 0 BUILDING DIVISION \1 I ...4_,„_.... . 51 33530 First Way South -A- 11--uarzFrt__ - \i‘liO' Federal Way,WA 98003 / ‘.,, ,:it.c)1\108:-8r.' i. . 97-->vd 6,3 0 (206)661-4000 Fax(206)661-4129c 0., &its' c-- 5e vi He APPLICiTle FSR BUILDING PER 0 T PLEASE PRINT .............. .................. APPLICATION 9 3 - 0 Li-SR_ iiiii.511416.411111111111111111111111111. ,dress ; /i :2.. ! 7 th ni;t, 5 q), r., ..,_ , 4t e)410 _____ --.L. Tenant(if known) Lot # , -, :ssor‘ Tax# \. -ew--.042i(O Building ONier's Nam , Address ' • e s lc. 2c7/0- 4. Ci 1 4 ', '€ AMA IL ' Ault,. i Z1 4 eal • ; • .11, : 2-9V,2f L__, _ Nature of Work . (Z11 i IT P. F-41..An L ty Re s i• e_ e__ ..,. ..,:*?,:itiii:immiii:i*i*iiii]iiiiiiiiimiiiiiiiiiii:ii KAITEICANSWEEM __. Name(F,M,L) ( Address 110 • ..:: State Zip 1 Co . Person _ i v r 61 7' I y Da&PZhonS—) ?/ 3-3Al I 11% Company Name i L7i...) rvle) St Address City Contact Person R& / ,,,,i a_ . i i t 1 25 . 12- /zy vi,75.- -Y&5-3 Contractor's #(card mu be presented) Expiration_ Verified Yes 0 No I., s • •R ' 1..)ei gi 2 6/ ' lei ifidafirdeftieNSIMMONE Name (SIM IP ) Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION A 0, Pk+ + k ) Pinrt.,',Ms.., that rcbe,... Existing Use �S� Proposed Use vra '� ::::;:<:::::::::::::::::?:>::::>:>�::::::ii:::::":_>:_::::::::>:i::i;::::::-:-:.: JL L li i,"(c ill t.: Permit includes: Ai Building Plumbing Mechanical 0 Other Type of Work: iji Residential ❑ New 0 Remodel Number of Units I 0 Deck 0 Commercial 0 Addition Garage 0 Shed 0 Other Enter 1st Floor 133 2 sq ft 2nd Floor /3 3 7 sq ft 3rd Floor sq ft Existing Floor Area sq ft Area Basement sq ft Decks sq ft Garage -112 ifit,. sq ft Proposed Total Area 2 tr 6`/ sq ft Water Availability 0 Sewer Availability 0 On-Site Septic System Availability 0 Project Valuation $ Zoning I Lot Size 2Cn) ,;Z 7/ r F, Existing Bldg Valuation $ 3}s��c2My' < p}r' f{•${:Yrtitt:{}.•i::{ah�j:•Y}[?�'�+;,x,It•-$: f•. �. 8:{i:v}: IName A eSs 8' sf 4: /1•0 �nf 1✓ter .., )l C 0, ?Ye .p n I City Rg--) I F'_ il L. i / P /D©(.' tate kr..lir JZ L/ I1 MECHANICAlitONTRAMOROMEE Contractor Name Address t 4, i City t State Zip Contact Xr - .it 0. r Phone Fax toe License # Expiration Date Verified 0 Yes 0 No Y:1 1_w {::i*::::�'::::::ii:�-:r::}�::.:::i:::i:::j-::::iii:::+::':::yri4:::?:��:::::.�.y��::::!::i:_:i:::::Li::i::': Contractor Name . Address City ) A. State Zip Contact 4 Phone Fax g License# if Expiration Date Verified 0 Yes 0 No I Water Closets 3 Sinks / Urinals Lawn Sprinklers Bathtubs 2- Dish Washers ) Drinking Fountains Other Showers / Electric Water Heaters I Sumps Lavatories Washin Machine in e Drains ,....tRJCt[CE'IDUflt ;<i-'i::z::Mi';:3::i .................: MgCHANIC AL t NI Cdu <'' ''' > MECHANICAL EVALUATION ONLY $ Fuel Type (electric/other) 64.3 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 X Gas Log ) Unit Heater 50+ Tons Furn >100 BTUs g Fans 5/ Miscellaneous Fuel Tanks Gas Hwt X 1 Hood / Boilers Above Ground Cony Burner Duct Work / • 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons ot_.._.nt-Ontrnt , 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 of the 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: �C Date: 41 / 7-C/ 2 6111owo.AT Rms.11/11/96 • LAKEHA EN 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 NC# SITE PLAN IS REQUIRED FOR ALL APPLICATIONS S/N # TYPE OR PRINT LEGIBLY /�� OWNER lC�. rY -� fi !Y-k12r5 2 2 . PHONE (92.5 ) X302--%/ZV PROPERTY ADDRESS :3'3/D7 - V714 J%'e S. id, c;dto ' ?n)C_3 i E� !G' °CIT�.L=' ! Fe3f BILLING ADDRESS 7/0 2a J.�, tIl. �' �� PLAT ,,L� ff� / LCITY y STATE ZIP LEGAL DESCRIPTION: NAME 5/g �CIrweiT— AAs! Rev' / Te LOT 2e BLK / -� 1 (IF APPLICABLE) OTHER LEGAL DESCRIPTION 7 c 54 'ei;ZT� AUTHORIZED SIDE SEWER CONTRACTOR PHONE BLDG. IDENTIFICATION TSS refemi-red NO. OF UNITS PER BLDG. WAS BLDG. PREVIOUSLY CONNECTED? YES, NO g IF YES, ACCOUNT # IS BLDG. CONNECTED TO WATER? YES 0 NO Lg IF YES, ACCOUNT # RESIDENTIAL }C 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 FOR DISTRICT USE ONLY IN LIEU OF ASSESSMENT CONNECTION FEES BILLING TYPE RESIDENTIAL 0 FRONT FOOTAGE $ NO. OF ERU NON-RESIDENTIAL ❑ OTHER FACILITIES $ CFC/CIC $ SIC GROUP DEVELOPER PAYBACK $ AREA CHARGE $ APT/CONDO/MH 0 SUB TOTAL $ BASIC PERMIT $ PUB AUTH ❑ RIGHT OF WAY $ DISTRICT IN 0 OUT❑ WATER DISTRICT PRETREATMENT $ LIFT STATION SUB TOTAL $ ULID TREATMENT TOTAL $ PLANT 1/4SEC BOOK D.P. INPUT COPY • ' 0 Ressential Sewer Use Certification KING COUNTY (To be completed for all new sewer connections, reconnections,or 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) Owner's Name Z2,ct-ryvr2 AleilleS IhC-, gPot King County use: (Last, First,Middle Initial) Ddiiti Property Tax I.D. Number /r? .?'.z - t02�O Property Legal Address: Monthly Rats Subdivision Name 5--ttty YIP hr00 k Subdiv. # 11: tx Month Due Lot# A Block# Building Name (if applicable) Property �1 Street Address ,33/0 7 " �/7 /rte S, Of City, State, Zip 1 P,rli.Q Wt /1 II)n 9 ' 0 3 Owner's Mailing UU Address XS-7/0- 212_ .ve_, S, �. (If different from ��J , > p /1�j d above) V))/Z ✓11P / er, j, // 9: 43 -UVJ_ d Owner's Phone Number(�) 93 2-r/.2..y ` Property Contact Phone Number ( ) Party to be Billed (if different from owner) Party's Mailing Address M (if different from above) • City or Sewer District 4a...,�e.- `z;.,VL,. Date of Connection: Side Sewer Permit# Residential Customer Please check appropriate box: Equivalent(RCE) Single-family 1.0 Li Duplex (0.8 RCE per unit) 1.6 L 3-Plex (0.8 RCE per unit) 2.4 Li 4-Plex (0.8 RCE per unit) 3.2 5 or more (0.64 RCE per unit) No. of Units x 0.64= I I Mobile home space (1.0 RCE per space) 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 resubmissio of corrected d t or determination of a revised capacity charge. Signature of Owner/Representative / 19 J Date —2—1-7-9 Print Name of Owner/Representative _RI, i7d4-kiey .-�re5/ee 1057(Rev.11/96) White-King County Yellow-Local Sewer Agency Pink-Sewer Customer Ressential Sewer Use Certification KING��«.�Y (To be completed for all new sewer connections, reconnections, or 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) Owner's Name it) Al,,r.vri4iiC' Ih, , For King County use: (Last,First,Middle Initial) Account # Property Tax I.D. Number i'9 g�'Q - 410/10 -' Property Legal Address: k Monthly Rate 4 Subdivision Name 5 7"v it e br,oo Subdiv. # ' Six Month Due Lot# •28-) Block # Building Name (if applicable) Property Street Address 33/07 - q7 Air I,'5 Iii, City, State, Zip t�PtXFlprr,_,,Q Willy, WTI ? 003 Owner's Mailing Address .g5-7/0a,11ue. 5, E. Of different from / ,J Vm� /�A above) 1fa,!e , W fr71J.71 Owner's Phone Number( yas) 932 - ?/.2.. V Property Contact Phone Number ( ) Party to be Billed (if different from owner) Party's Mailing Address (if different from above) City or Sewer District Lie-AaA)041- Date of Connection: Side Sewer Permit # Residential Customer Please check appropriate box: Equivalent (RCE) l Single-family 1.0 Duplex (0.8 RCE per unit) 1.6 U 3-Plex (0.8 RCE per unit) 2.4 LJ 4-Plex (0.8 RCE per unit) 3.2 5 or more (0.64 RCE per unit) No. of Units x 0.64 = I Mobile home space (1.0 RCE per space) - 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 resubmission of corrected d t or determination of a revised capacity charge. Signature of Owner/Representative /�Cc--1)/1 - ie%. ,7 Date -7`/7"C7 ? Print Name of Owner/Representative f 2y' I/ah k%(/ - lre'5/4Ew 1057(Rev.11/96) White-King County Yellow-Local/ Sewer Agency Pink-Sewer Customer . 0 4110 Resential Sewer Use Certification (To be completed for all new K„�COUNTY p sewer connections, reconnections, or 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) Owner's Name �,� f), For King County use: (Last,First, Middle Initial) Account# Property Tax I.D. Number , _1819 FeVO ' Da?0 Property Legal Address: Monthly Rate Subdivision Name , loop }fir(Jo�c _ Subdiv. # _ ` Six Month Due Lot # ,28 Block# _ Building Name (if applicable) Property Street Address 33/07 — 97 f” Air 5, ), City, State, Zip 'er 3 Owner's Mailing � Address �{S7/U- ;1 I- h71 tit". 5. E.., (If different from above) } ') q 'r���>l G`r�..I/&2 / n .b,35_ Owner's Phone Number ( )'2 5-) -3 2 - �J`I',c y Property Contact Phone Number ( Party to be Billed (if different from owner) Party's Mailing Address (if different from above) City or Sewer District Ladc.e/1.a.,- Date of Connection: Side Sewer Permit# Residential Customer Please check appropriate box: Equivalent(RCE) Single-family 1.0 Duplex (0.8 RCE per unit) 1.6 3-Plex (0.8 RCE per unit) 2.4 L 4-Plex (0.8 RCE per unit) 3.2 1 5 or more (0.64 RCE per unit) No. of Units x 0.64= Mobile home space (1.0 RCE per space) 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 resubmission of corrected d t or determination of a revised capacity charge. Signature of Owner/Representative / �- 1/t - Date -7'" Print Name of Owner/Representative z' �/� r >rC-/Pt/ 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# SITE PLAN IS REQUIRED FOR ALL APPLICATIONS S/N # TYPE OR PRINT LEGIBLY �pVv -t-' OWNER J /i' rev/ A/( q, '$ 1 7t . . PHONE ((�,I:Z.S' ,)'f3� yz2 V PROPERTY ADDRESS 33/g 7 - 97 e lV Cl�e ra d Q� '���1 BILLING ADDRESS ,2c 7/r�' V-? /tie c , I2 -/eI Oma`/e I STATE PLAT _ "' / ZIP LEGAL DESCRIPTION: NAME 'nY�/I/DOl- TLSI 2 Jk?�t� LOT 2` BLK (IF APPLICABLE) OTHER LEGAL DESCRIPTION P/a u i" Th5' AUTHORIZED SIDE SEWER CONTRACTOR PHONE BLDG. IDENTIFICATION / P 5IGC n/ial NO. OF UNITS PER BLDG. WAS BLDG. PREVIOUSLY CONNECTED? YES ❑ NO ❑ IF YES, ACCOUNT # IS BLDG. CONNECTED TO WATER? YES ❑ NO ❑ IF YES, ACCOUNT # RESIDENTIAL X 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 I FOR DISTRICT USE ONLY IN LIEU OF ASSESSMENT CONNECTION FEES BILLING TYPE RESIDENTIAL 0 FRONT FOOTAGE $ NO.OF ERU NON-RESIDENTIAL 0 OTHER FACILITIES $ CFC/CIC $ SIC GROUP DEVELOPER PAYBACK $ AREA CHARGE $ APT/CONDO/MH 0 SUB TOTAL $ BASIC PERMIT $ PUB AUTH 0 RIGHT OF WAY $ DISTRICT IN 0 OUT❑ WATER DISTRICT PRETREATMENT $ LIFT STATION SUB TOTAL $ ULID TREATMENT TOTAL $ PLANT 1/4SEC BOOK ENGINEERING COPY