97-102609 �
g�. �aa�a�
C�I�("`A Q�" �� F PE:F',s�!_ ✓�ir�Y PERMIT NU: BLD97-0430
3 3 5 3 0 F i rs t w a y 5 o u t h .�"'J�b„�p.1N;: �I!„„,..�M;:;X.,�,. IIrM�n��::l� ���i��i�;IN����.�!�: ��I���� I S�u C L�: U 8/21/�7
FeG�ra1 Way, WA ��80f]� .�uilc�:iny Inspection Requests 25�--661--�t1�+0 BY: �C
253--661--4000 EXPTRES: Q2/17/98
RDDRESS: 33Q�3 47TH AVE �W
NQ. : 1898q0-C12 7Cl
PROJECT DESCRIF"CIQN:NSF - Basic Plan A97-1001-V44
:j
NSF - WITH PLUMBING AND MECHANICAL
BASIC # 91-1007-V94
�= OWNEft ==_____��_��__________________________________����T= CONTRACTOR =___====_=__==___=_______=__-_=______==-==T= LENDER =-_____=_=_____=_=___=====_==___=_���_�__��T=_�
' LEBARON HOMES INC. � LEBARON NOhIES INC � CONTINENTAL MORTGAGE C0. �
25710 212TH AUE SE � 25710 212TH AVE SE � 11555 SE 8TH ST., #110 j
� MAPLE VALLEY WA 98038 � MAPLE VALLEY WA 98038 � BELLEVUE WA 48004 �
� 425-432-9124 � 432-9124 � �
� � LEBARHI099L1 � � �
1..._,..__._ __—__...._�____�_._______..��.,__.___•�_._______._._.�_..._ ._....._____�__....__......__.__.........,..._.___„__..._.._...__._.___.__..._..___"_"".._�._¢s::.cxc:zx:a�r.cac ..___e�...........________:a_�.amec_�_.�.-ccc::=aa�
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��� �i� CONTRACTORS, PLEASE USE LOCATION CODE 1732 MHEN REPORTIN6 SALES TAX FOR PROJECTS YITHIM TkE CITY OF FEDERAL UAIf. TAX RATE = 8.2� x=*
--_--_.-----------=----------.--__==_==___=_��:���___=__��:�=__===_===_____===___-----------------�--____-_-=--_--____�___-__=_=_______---____--.,_-------::::���:�Y�-��===_=_____=__=
r--------- ----- -- ------ q____.._-----____- ----- -__ _.. ______ _- - --
T-------____ .._ �
� BLD?:X MEC?:X PLM?:X FLR--EXIST--PROP--- DWEILING UNIiS: 1 � COMP PLAN,,.......:URBA � FEES: �
� TYPE OF WORK:NEW USE:RES 1ST.: 0: 1422:sf STORIES.....,..: 2 � REQUIRED PARKING..: 2 SPRINKLERS?......:N � PLAN CHECK fEE $ 100.00 )
� CENSUS CATEGORY.....:101 2ND.: 0: 1009:sf HEIGNT.....: 21.00 ft HAZARD CLASS...:? � PUB WKS PLCK(Sf)..93 $ 80.00 �
! OCCUPAMCY GROUP---------- 3RD.: 0: O:sf VALUATION---------- REQUIRED SEIBACKS------- FIRE FLON....: 0 gp� � BUILDING PERMIT....# � 916.00 �
� :R3 :U1 :? :? : OTHR: 0: O:sf EXIST..$: 0 FRONT......,..: 20.00 ft � Mechanical Permit� $ 54.00 �
� TYPE Of CONSTRUCTION----- BSMT: 0: O:sf PROP.,.$: 118342 SIDE,.........: 5.00 ft WATER SERUICE..:FED � SBCC SURCHARGE.....� $ 4.50 i
� :5N :SN :? :? : DECK: 0: O:sf ! REAR..........: S.00:ft SEWER SERVICE..;FED SCH IMDACT (SfR)NEW $ 2372.00 � �
� OCCUPANT LOAD------------ GAK.: 0: 681:sf RECEIVED.:07/17/47 PLUM9ING FIXT....93� S 98.00 �
8: 0: 0: 0: TOTL: 0: 3112:sf � IMPERV SURFACE: 2411 sf SENSIIIUE AREAS?.:Y �
-__-_=___
_-�����-��=�=�_____________________________��_��==_��_���__=__=__ ______________._��__------�______________=_��-=�_��:��
- ---
� FUEL TYPES.:GAS GAS FANS..........: 4 BOILERS/COMPRESSORS ; WATER CLOSETS......: 3 URINflLS........: 0 % TOTAL FEES $ 3624.50 �
� GAS PIPING.: 0 ft HOOD.....,....: 1 0-3 TON.....: 0 � BATH TU9S..........: 2 DRINKING FOUNT.: 0
� FURN<100K... 1 DUCT WORK...... 1 3-15 TON..... 0 SH04tERS............. 1 SUMPS........... 0 � �
( GAS NWT....: 1 WOOD STOVES.,.: 0 15-30 TON...: 0 � LAVATORIES.........: 4 VAC BREAKERS...: 0
� CONV BURNER: 0 fURN>100K.....: 0 30-50 TON...: 0 � SINKS..............: 1 DRAINS.........: Q � �
� BBO........: 0 MISC.,.,......: 0 50+ TON.....: 0 DISH WASHERS.......: 1 IAWN SPRINKLERS: 0 � � �
� GAS DRYER..: D AIR NANDLING UNITS FUEL TANKS--------- ELEC WTR HEATERS...: 1 OTHER FIXTURES.: 0
� RANGE......: 1 t=10,OD0 CFM: 0 ABOVE GROUND: 0 LAUN WSNR OUTLTS...: 1
� GAS LOGS...: 1 > 10,000 CFM: 0 UNDERGROUND.: D > � �
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PERMITS EXPIRE ISO DAYS AFTfR ISSUANCE IF MO MQRK IS STARTED. RESIDEMTIAL AMD 6RADIM6 PERMIIS EXPIRE OME YEAR AFTER DATE OF ISSUAIICE.
I CERTIfY THAT TNE INfORMATION fURNISNE ME IS TRUE AND CORRECT TO TNE BfST Of MY KMOIILED6E AMD TNE APPLICABLE CITY OF FfDERAI MAY REQUIREMENTS MILL BE MET.
0'�NER OR AGENT ---. , L�'�t- _ ;�1.. _.__.. __.,... ..__. _ntiC� �.
� � , DATE .�S_�L.^1..�..--
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FIELD COPY
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'• SETBA � . >=00TINGS
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Date -� t�— �j� BY � . �.-r,,..1
� 2 FOUNDATION WALLS ''
Date ' :, _ 7,,� � -
% �"` c.��c� Y
3 PLUMBtNG GROUNDWORK
Date By
_ __ __ _
4 SLAB INSULATION
Date By
5 FOOTING/DOWNSPOUT DRAINS ; �� d
Date — ��.e L` By �.,
6 UNDERFLOOR FRAMING
Date By
7 SHEAR WALLS
Date � — � 5—`�� BY[ ,� �
8 PI:UMBING ROUGH-1TI ''
Date _ Z^ By �
9 (3A5 PIPINQ
Date (, - z�- r/By C
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10 MECHANICAL ROUCiH-1N
,: , _,::
Date G ' Z3- �BY _
11 FRAMING'
Date _ � 3_ �'1 By L(.�.�
12 IN�U LA'f ION
Date 7— /3` �� By � :
13 GWB � 1ST LAYE�1
Date ._ � _ By
14 61N8 -2NQ LAYEi3
Date7 Z?— __ By
_ . _ __ _ ._ ____ _.
_.. _. _ _ _ _ _..__ .
_ . ..._ _._ . _ _ _ _ _....
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15 SUSPENDED CEILII�G i
Date By
16 PLANNIN(3 FINAL
Date By
17 PUBUC WORKS FiNAL
Date By
18 Flq� �INAt C� c,� dv �,L�ovu�-c T �
Date By •
19 BiJILDING FINAL
Date _� Z— By
_ _._ __ _
20 GITHER »'
Date By
C00193(Rev 4/8�
� • - ,''�;,',. BUILDINGDIVLSION
� G ���-LL�` 33530 First Way South
uV FiY E1ZAi_ , ��';`,
Federal Way,WA 98003
'� � (20�661-4000
,�v,- Fax(206)661-4129c
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APPLICATION FOR BUILDING PERMITc�Pn�� a�,v
PLEASEPR/NT APPUCATION # ��-�� } �'��
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Building Owner's Name � Address
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Permit includes: Buildin Plumbin Mechanical ❑ Other
Type of Work: � Residential �4 New ❑ Remodel '� Number of Units,� . Deck
❑ Commercial ❑ Addition Gara e O Shed ❑ Other
Enter 1 st Fioor�,�,2 sq ft 2nd Floor �� sq ft 3�d Floor sq ft Existinp Floor Area sq ft
Area Basement s ft Decks s ft Gara e s ft Pro osed Total Area ^�r— s ft
Water Availabilit ❑ Sewe�Availabilit � On-Site Se tic S tem Availabili O Pro'ect Valuation S
Zonin Lot Size ,( �`,.
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License# Ex iration Date Verified ❑ Yes ❑ No
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Contractor Name Address
C� State Z
Contact Phone Fex
License# iration Date Verified ❑ Yes ❑ No
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2�1�,EN��i�;t't.�E3�.CC�U�1T;:.;:.::;,,,.::.;:.;;:.;:.:.:;..
Water Closets � Sinks j Urinals Lawn S rinklers
Bathtubs Z Dish Washers � Drinkin Fountains Other
Showers Electric Water Heaters Sum s
Lavatories
Washin Ma
chine
Drains
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yx}xi:si:iriJ�Fj?::j3:i?;i}:,{�,@;j>.y�}?'.{i:4SYf.0'�ti�„ii;i{i_:;r;:i:j.4}{{i;i::::i�:�:{%,::S�ti.:::
���J��1C#��:�N�'�:.CC���!':<:�?�v<:::;«:,�;�:.:;<:: MECHANICAL EVALUATION ONLY S
Fuel T e(electric/other) T " � Gas D er Air Handlin < = 10,000 CFM 15-30 Tons
Len th of Ges Pi in Ran e Air Handlin > = 10,000 CFM 30-50 Tons
Furn <t00K BTUs Gas Lo Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscella�eous Fuel Tenks
Ges Hwt Hood Boilers Above Ground
Conv Burner Duct Work 0-3 Tons Under round
BBa�$ Wood Stoves 3-15 Tons 1`atal;ljnt��`nvrlt
D IS CLAIM ER:I ceRify undec penahy of perjury t}wt the infortnation fumished by me is ttue and oorrect to the best of my knowledge,and furtha,that I am authoriud by the owna of
the above prcmises to perfam the work for which pertnit application is mada I further ag[re to save harmless the City of Federal Way u W any claim(including costs,expetues,and
attorneys'fas incvrt�ed in investigation and defense ofsuch claim),which may be made by any pusoc4 including the undersigned,and filed agawt the City of Fcderal Way,but only
where such claim arius out of e reliance of the city,including its officcYs and employees,upon the aocuracy of the infortnation supplied to the city as a part of this applicatioa
Owner/Agent: �� �^ " Date• �— f �—� �
BtRD�IO.AR
11EveEo tt/11/06
, O Res _ �ntial Sewer Use Certific..«on
K,.�,:o�.rY (T o b e c o m p l e t e d f o r a l l n e w s e w e r c o n n e c t i o n s, r e c o n n e c t i o n s, o r c h a n g e o f u se o f exis ting connec tions.
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 �,�e. ��e-rQ 1'� .rn.�r'S .�t For King County'use.
(Last.First,Middle nitial) � ACCOUI1t#, __;, __�, _.T,
Property Tax I.D. Number_ _ �_� ��C� '�2��' -
Property Legal Address: Mc�nthiy Rat�.._ _. ..._.�_ ___.__ __ _ ___. . _ ,
Subdivision Name�'�"an,e.�J��� Subdiv. # �;x Manth Que
-- — _ __
Lot# �7 Block#
Building Name
(if applicable) � <
Property � ' � ��f
���q � � -�
�
Street Address�.3 C�.3� "y7 �(/� S� KJ' . � �
$ - � � ' �
City, State, Zip �,�c� �Q.Q.���' 9"8��1 Q�
Owner's Mailing �/�
Address ��,/D - 2/�.�� y}L��. S, ,
(If different from
above) �( / �� /���/i�� ����D
/�—►�si�6�� !rl
i
Owner's Phone Number(�) �.�2— ���y
Property Contact Phone Number ( ) � .;
Party �
to be Billed
(if different from owner) ` - ' ''
�
Party's Mailing F �
Address
(if different from
above)
City or Sewer District�,�� ,�j,c�.(J�n„_
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
❑ 4-Plex (0.8 RCE per unit) 3.2
❑ 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 resubmiss' n of correcte a for determination of a revised capacity charge.
Signature of Owner/Representative � �-� �— r--�-v Date � "� •—�i
,
Print Name of Owner/Representative��4�1t���f�-S/�
ios��Ae�.iuss> White—King County Yellow—Local Sewer Agency Pink—Sewer Customer
LAKEHAVEN UTILITY DISTRICT OFFICIAL USE
P.O.Box 4249 •31627-1 st Avenue South•Federal Way,Washington 98063 APPL#
Seattie: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
OWNER �2 T��t Y1�YL _�YYl P S �1''l L PHONE (��) ��;.�- q�%�7
PROPERTY ADDRESS ���13� " � � � ��
� v ,J ` � � CITY / IP�
BILLING ADDRESS T�� e
�f r IN S ATE ZIP
LEGAL DESCRIPTION: NAME ��'" � a �-� ����� LOT � BLK
I � (IF APPLICABLE)
OTHER LEGAL DESCRIPTION ��l.�� o� �t� �n ��'�✓L��
AUTHORIZED SIDE SEWER CONTRACTOR PHONE
BLDG. IDENTIFICATION ` �°- 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 _�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 ❑
FRONT FOOTAGE $ NO.OF ERU
NON-RESIDENTIAL ❑
OTHER FACILITIES $ CFC/CIC $ SIC GROUP
DEVELOPER PAYBACK $ AREA CHARGE $ APT/CONDOJMH ❑
SUB TOTAL $ BASIC PERMIT $ PUB AUTH ❑
RIGHTOF WAY $ DISTRICT IN ❑ OUT❑
WATER DISTRICT
PRETREATMENT $
LIFT STATION
SUB TOTAL $ ULID
TREATMENT
TOTAL $ PLANT
vaSEC BOOK
D.P. INPUT COPY
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