03-104850 , �.'t ; �
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i'City of Federal Way�—� Bui�ding - Single FamiYy Permit #:03 - 104850 - bo - ��,` �
Coinmunity Developmen[Services _ �
33530 lst Way S
Federal Way,14'n 9A003-G210
Ph:253.661.4000 Fax:?53.661.4129 Inspection request line: 253.835.3050
Project Name: GORBUN
Project Address: 31014 48TH AVE SW Parcel Number: 184080 OOl 5
Project Description: NEW-Construct new single family residence with attached garage,including plumbing and
mechanical. **3 Bedrooms,Estimated Selling Price$280,000**
Uwner Applicant Contractor Lender
ANATOLIY&TAYA GORBUN ANATOLIY&TAYA GORBUN ANATOLIY 3c TAYA GORBiJN TIMBERL��\'D SAVING E3ANK
1311� 111TH AVE CT E 13115 111TH AVE CT E 202 AUBLIRN WAY S
PUYALLiJP�`JA 98374 PUYALLUP WA 98374 13115 1I1TH AVE CT E AUBURN WA 98002
\ \ PUYALLUP WA 98374
Includes:
Census cate o _—. 101 -`� ��s�y-l— - �, . _��-- #2 , ` #3 — #� _.
g rY _ i � �L _ '
__ -r.� .,���� �
Occupancy�roup �.---- �� ---- -- -------- I _ . __ �
—� � ��
Ocnutranc1OLaacl.e. _-_ :-_:.- _=__— � —TYPe�'_N--�L --_ �_— I;i = _-_ ---- ��-__ -__ --_-�,
--...._p.�Y�_ __ _�. __..__-�._��,��_,—__�_� - � �._z-_..a__� �
�---� - _,.—__�- _.�_� _...� � _� -- ,
Floor Area(Sq Ft.}: � �� i i �
--- -----._. . __ �._.
ls�Floor Peoposed Sg:Feet... ............................1587 2nd Floor Proposed SqCFeet ..�...... ............l i43
�;asic Plan......... ..:...:. ...:a................ T�o Census Gategory............... ...�:.... ..°......... 1D1-Pd:w singl:;Pr.mily housc
tiazage Proposed Sq.Feet .. ....... ...........�....�62 Height of Structure............... ...;.:25.5
Mechanica:............. . . .':.................. , Yes Occupancy Group#1...:;... .......................;..R-3
Plumbing..........................................:....:. Yes Totai Building Sq.Feet........................................3192
Total Proposed Sq.Feet.......................................3192 Zoning Designation............................................RS 7.2 ,� �,`
_..�. �;. .� �,
�:s
Plumbing Fixtures
i _ Description 'jQu t� ___ Description` Q t ty `___ Descnpti n l�Quantity! ,,
�-— -- — -- -- — ---- — - - ,
I� Batl�tubs i 2—�rIDishwashers 1 i Laundry Washer 0 ta � '
�----- -- - — �_.— J L� — ------� J,. — --- -__. _-----------.. ..._.i�:..._ .._.._.. ' .
-- -_
Lavatories �� 5 �r Showers � 1 'I � � 2
� -- - -- �� _,�� — � - _ ---- - � - _,
Water Closets �I 3 �Water Heaters 1 � �
! �
�--- -- -- -___` _�� -- - -
Mechani�al Fixtures
� -- --- — -- — --- --- -- _ -- -- --
__.
' Description _ __�iQuantity L___ Description__ __ QuantityJ _ Des �n ;Qua�tityi
-_ __ ,-- _ �
_ _ - — - - -- -- ._ __.
-- - ----
I Fans �I 3 F eri place Inserts 2 i Furnaces 1
�---- --- _- -----JL- � ---- —�— I�--- _ - - -- iL_ _,
r�ods -- ---- --- I� Ranges — —�� i
CONDITIONS:
1).A soils compaction report will be required for the fill that will be placed in ditch so the home can be located next to and
over the ditch. The report shall be stamp and signed by a licensed Washington State geotech engineer. Ti�e report shali be
submitted to the City of Federal Way building inspector at time of footing inspection.
2)The roof downspout system for this structure must be approved and installed to the satisfaction of the Public Works
Department prior to certi�cate of occupancy. Final inspection will not be sheduled until the system has been installed.
3)The driveway shall be constructed of pervious pavers set on 4" of sand underlain by 6" of gravel.Sod shall be hand
placed in the interstices and in good growing condition prior to certificate of occupancy.
4)Service connections for electrical&communication facilities shall be placed underground per FWCC,Sec.16-48.
5)Prior to any clearing or grading on a lot,the owner/builder shall install temporary erosion/sedimentation control facilities
approved by the City.These facilities must ensure that dirt or sediment laden water does not enter the public drainage
system,adjacent lots or public streets.The owner/builder bears the responsibility to maintain the facilities in proper
working order,i•eplacing as necessary.The facilities may be removed only after such time as construction is complete c�:
landscaping is inslalled.See attached for staudards and site plan for location of silt fencing.
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PERMIT EXPIRES October 2,2004.
Permit issued on Apri15,2004
' I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accardance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
�.
Owner or agent:� ,`� ' Date: ��
, . � * `♦
,, ', � •' � POS. [IS CARD ON THE FRONT OF�UILDINr'' � ' �� ' .'
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�'°,���ra� �a BUIL�,ING DIVISION
Y INSPECTION RECORD
INSPECTION REQUEST PHONE#: 253-835-3050
PERMIT #: 03-104850-00-SF
OWNER'S NAME: ANATOLIY & TAYA GORBUN
SITE ADDRESS: 31014 48TH SW � Dr•1' ,(�Q
' j T�t'Yt.� ���S(o(� l'��11�-DL � 7 � -�L�
( ) FOOTINGS/SETBACKS��"Z'���F ( ) FOUNDATION WALL� �!�" C� yG
DO NOT POUR CONCRETE UNT�L"THE ABOVE IS APPROVED
( ) DRAINAGE: Line 6� ( ) Connection
O N T POUR SLAB UNT1L THE ABOVE IS APPROVED
( ) UNDERFLOOR FRAMING_ � ! � O y
( ) ROUGH PLUMBING: DWV / � (� � Water piping � �� 4 �"�
( ) ROUGH MECHANICAL� -� ..► Gas piping -� �-
( ) SHEATHING Roo .Z7►.v � �` � Floor
( ) SHEAR WALLS �..t,�- '2„']--Q c� `/,..
( ) ELECTRICAL ROUGH-IN _ Ditch Cover
( ) FIRE/DRAFTS"TC►PS
` ALL THE ABOVE MUST BE APPROVED PRIOR TO FRAMING INSPECTION
( ) FRAMING/FIRESTOPPING O �J�
THE ABOVE MUST BE`APPROVED PRIOR TO SULATING O SHEETROCKING
O INSULATIOi'• Floors Walls �� �� G'T Attic
THE ABOVE MUST BE APFROVED PRIOR TO APPLYING,SHEETROCK
O WALLBOARD NAILING�L�,� l�(�,. p � O SUSPENDED CEILING
THE ABQVE MUST BE APPROVED PRIOR TO TAPING OR INSTALLING CEILING TILE
( ) ELECTRICAL FINAL
( ) PLANNING FINAL
( ) PUBLIC WORKS FINAL
( ) FIRE FINAL
THEABOV T APPROVED PRIOR TO BUILDINGDEPARTMENT FINAL
� BUILDING FINAL ] .
DO NOT OCCUPY THIS BUILDING UNTIL BUILDING FINAL IS APPROVED
„ �,• � ( 7 , ' � 1 . � I • � ` �.
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INSPECTION LOG '
' AATE ' INSPECTOR OK CORR/REJ' ' AREA AND TYPE OF INSPECTION
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- ` � CONSTRUCT J PERMIT APP�CATION
CITY OF � ��
b PPLICATION NUMBER: Q� - LQ �U- S
Federai Way `�a 1 PPLICATION NUMBER: _ _ - _ _ _ _ _ _ - _ _
� PPLICATION NUMBER: - - - - - - - - - -
3 I�� �g he following is required information-Please print(in ink)or type*•
� y � $a�
Please3n e: Electri 1 �e Preventio�S�ems and Engineering permits may require a separate application. ��
• • • . • �
SITE ADDRESS: ��/ ASSESSOR'S TAX/PARCEL #: L � �D9 D - (D O L�
LEGAL DESCRIPTION OF UBJECT PROPERTY(ATTACHSEPARATE DESCRIPTION IF LEN THY): 't" ,CJ/(�G,� �
` c� CCC?rC�-�ri , �� .
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• . . • .
TYPE OF PROJECT(This application): �BUILDING o PLUMBING o MECHANICAL a OEMOLITION
o ELECTRICAL o ENGINEERING o FIRE PREVENTION SYSTEM
/�I�L,J ClSY1.I't'('C.tC�'�'V
PROJECT DESCRIPTION(Provide detailed description): \/1 ' � �G� h�Q� L.�J t�
Z CCc�'' � S F F/ °7
,
�GLin I�- I�5 g� SQ. +� ;� `rr�hh a bonu s ressm o F 4L� SQ� �'i.
PROJECT NAME: `-E O V bU�
• • � • •
PROPERTY OWNER• N^ME: � DAVTIME�HONE:
� �4n�ol? � � "r�� �p,2.Qu� ' � �26��' 4Z7- 4�37'Z�
�
� ; ��311�S� I i j�iss:�,�t�. � . R �� f�_�" �°�"3 7� ;
�
CONTRACTOR- NAME: flnvrt G PHO e•
�o�.� � �-r�c� � �G (�S�L� C�l(-� c�`b� �Z�-�37z
- �,t� '
i MAILING ADDRESS(SfREET ADDRESS; STATE.ZIP): EVENING PHONE'
T B�� � 13 I �S- 1 I I� � C�. �', 1�4�oN,.c.-+p(253)4��-�$ i
� CIiY FEDERAL W BUSINE55 IICENSE UM R� �� � FAX NUMBER:
Art,.(o�-✓ �-`� W���'� - - _ � (l�3 )�� -�� i
CONTRACTORS REGISTRATIO UMBER: � IXPIRATION DATE:
�roPY of Card required) 1 � �
APPLICANT: NAME: , i DAYTIME PHONE'
~�C��� �` l i9 �?--o��� � t�) �fZ� -r437Z-;
I MAILING AI vl I� /�IR $ C1TY�ZI , �. n"'_��/� ��.J�� I � ZIS�%ONE� �_�� I
T�1 (�� �'/1 L
TT
I RElAT10NSHIP TO PROJECT: i FAX NUMBER: '
I ❑ ARCHITECT 0 TENANT ❑ OTHER(DESCRIBE): , �ZS?��� -�� !
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j E-MAIL ADDRESS: I
I i
CONTACT PERSON FOR THIS PROJECT: PROPERTY OWNER D APPIICANT o CONTRACTOR �
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� r : � • • •
EXISTING USE: /V � EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: � PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑YES �NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES�NO
� �.
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGNLINE J�TACOMA O PRIVATE(WELL)
SEWER SERVICE PROVIDER: O IAKEHAVEN o HIGHLINE �PRIVATE(SEPTIC)
/�
#*NEW RESIDENTIAL CONSTRUCTION OI' * �
�
NUMBER OF BEDROOMS: -� ESTIMATED SELLING PRICE: � Z�Vi � �
• • • • •
FLOOR EXISTING S .FT. PROPOSED S .FT. TOTAL
BASEMENT
�`�sr S8 7 SQ,a-T
SECOND �� S�
- - THIF�D.. .. .x. : •• �4 �
♦ _..
���. y �J V
��FOURTH
�� �
OT R��(�DE,S�C,,RIBE) �� (^� �,
J
DECK
GARAGE /�f/��
HOW MANY FLOORS? � �t�
TOTAL: � ��� r`7� � Z • �
Indicate number of each type of fixture m� (f CA�S-� ��t
ECHANI
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) � GAS LOG(S) _�REFRIG.SYSTEM(S)
� BBQ(S) � FAti(S) �_ NOOD(S) _�_ WOODSTOVE(S)
� BOILER(S) FIREPLACE INSERT(5) t RANGE(S) MISC.( )
COMPRESSOR(S) � FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE:�EIECTRIC ❑GAS
PU1h9BYPlG
Z BATHTUB(S) �� LAVATORY(S) �_ URINAL(S) ' WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) `�ELECTRIC ❑ GAS
DRINIQNG FOUNTAIN(S) � SHOWER(S) 2 WASH MACHINE OUTLET (,
GAS PIPE OUTLET(S) SINK(S) � WATE�CLOSEf(S) � MISC. 'l0 � )
INTERCEPTOR(S) , SUMP(S)
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I certify under penalty of pe�jury that the infoRnation furnished by me is true and correct to the best of my knowtedge,and'
furtfier,tl�at I am authorized by the owner of the above premises to perform the work for which the pennit application is made. I •
futther agree to hold harmless tfie City of Federel Wajr as to any clalm(induding costs,expenses,and attomeys'fees incurced in the
Investigation and defense of such claim),which may be made by any person,induding the u�dersigned,and filed agai�st the City of
Federal Way,but oniy where such claim arises out of the reliance of the dty,including its officers and employees,upon the accu�acy
of the(nfortnation supplied to the city as part of this application.
NAME/TIT�E: � DATE: ���-T���
�PROPERTY OWNER �APP CANT ❑ CONTRACTOR
_ _
..F.OR OF�ICE.USE�ONI.Y.<�;
'��NEW�� . �a�ADDI7ION��'q ALTERATION���"�n,REPAIR��=.x n..TEN "` "` _.�� „„��,� ,
,w�_p� ..
., _�" � ANT�IMPROVEMEIYT�F�-�_, .;;;
*CENSUS::CODE.����'���-�•�;':°���� ����LOT.SIZE;�'������'"��`�„�-�:�?-x�-� .:� �;-�,�
{ZONING'rDESIGNATiON�:���,��"�'}����'����'����BUILUING.SHELL�ONlY7a�°o YES:�s:a NO �"
COMPPUIN DESIGNATIUN� .� �� _ {.:�-�'' ?BEISICPLAN?'�:�=�YES �: �O NO���"
`'SECTION��•,,-r -�,�-TOWNSHIP ��. ,�R/1NGE ?�;'�, _NEW ADDRESS RE UIRED? �:'.���'YES�_ °t3'NO �,' Y
^P.t:ATTEU'LOT7 �s❑]fES:k �=o'NO ,�`��;,�'����'�=°` �� `�CIiANGE OF USE?,� ` -r T]YES"�-0 1V0 �
COMMUNITY DEVELOPMEhIT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661�129
rrvvw.citvofFederelway.com
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j ' Con�uction Pef�rx�it F�e Calculation�eet
4 *******PLEASE NOTE: ALL FEES MUST BE VERIFIED BY CITY STAFF PRIORTO ACCEPTANCE OF PAYMENT.
� CHECKS FOR INCORRECT AMOUNTS WILL NOT BE ACCEPTED!*******
euilding,mechanical,and fire prevention system fees are based o�ttie following schedule.
TABLE A
TOTAL VALUATION FEE FACiOR
(1)si.00 co Ssoo.00 (i)�30.00
(z)5501.00 to 52,000•00 (2);30.00 for the first;500.00 plus f9.A�foreach additionalSICO.00or fraction thereof,to and induding
5�,�.00
► (s)S�.00i.00 to Szs.000.00
(3)f90.00 for the first;2,000.00 plus 518.00 for eaoh addi[ionalSI,OGII.LYJor fraction thereof,to and
indudir�525,000.00
(4)$25,001.00 to 550,000.00
(4);504.00 for the Tint�25,000.00 plus 513.00 for each additiona/SI.OGb Gt�or fradion thereof,to and
irxiudi�9 SS0.000.00
(S);50,001.00 to$100,000.00
(S)5829.00 for tfie first j50,000.00 plus 59.01�foreao5 adddiona/f10Y70OYI or fractbn tliereof,io and
including;100,000.00
(6)j100,001.00 to 5�,000-00
(6)j1,279.00 for the ttrst;100,000.00 plus S7.IX1 for each addi[ionalll Lb0 A�or fraction thereof,to a�d
indudin9$500.000.00
��5�,�1.00 to 51,000,000.00
(�f4.079.00 for tfie fist#500,000.00 plus,f6,00 for ead�add'tiona/5101�IXI or(radion thereof,to aM
kxludin9 51,000,000.00
(8)j1,000,001.00 a�d up
(8)�7,079.00 for the fint�1,000,000.00 plus 54.50 for earh addibonal SI Oq0 00a(ractio�thereof.
Bold�umbe�Is the base fee for the spedrted Maeme�t
Tta//dred under/lned namber/s the fee acr addlf/ona/soedred/naremen[
PLUS: Add 65 percent of the base buliding permit fee for plan revlew fee.
Add 2S percent of the base mechanlpi pertnit fee for mechankal pla�revlew fee. -
Add 15 percent of the base building permit fee for Flre Distrid#39 wrcharge,commerdal only.
, Add$4.50 for WA State Building(:ode Coundl,plus$2.00 per unft for duplex&above.
**Electrical,plumbing,and medianlcal fees are plcuiated separatety**
PROPOSED VALUATION: ,
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (1)
Estimated Plan Review Fee: (2)
Estimated FW Fre Department Surcharge: (3)
(COMMERQAL ONLI�
PROPOSED VALUATION: �I Z�'-}
FEE FACTOR FROM TABLE A: Number: ! `' �
(a)Base Fee: _ "r' �::
(b)Additional�ncrement Fee: 3`�. �
Estimated Permit Fee: (4) � Z�, �l
Estimated Plan Review Fee: (5) 3Z , L��?
•
PROPOSED VALUATION:
FEE FACTOR FROM TABLE A: Number: (a)Base Fee:
(b)Additional Increment Fee:
Estimated Permit Fee: (6)
Estimated Plan Review Fee: (7)
Bax Fee Number of FxGxes
$26.00+{ X$9.00/fixture}_ (8)Estimated Permit Fee
Esanwted Pern,R fee '
� X .65= (9)Estimated Plan Review Fee
Miscellaneous Fxture Cha�-ge:(10)
SUb TOtal <�aqeone): line(s)(1)+(2)+(3)+(4)+(5)+(6)+(7)+(8)+(9)+(10)_ (11)
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TABLE B �
NEW RESIDENTIAL SERVICES MOBIIE HOMES MISC EQUIPMENT/TEMP SERVICES �
Singie Family _Service or fccdcr only.........................$57.00 _k o(Thcrmostats(�irst-$43.00;add'n-$13.00ca)
(First 13UU ft'-�R5.50;fach add'n$00 ft -$27.Spj _Scrvicc and(ccdcr....................._........�93.00 _H of Low voltage firc or burglar alarms
iquarc Pcet: firs�2500 tl'-$50.00:I:ach add'n 2500 ft`-513 0(;
Liach outbuildino or garagc.._. ._...._.........�3�.50 � Square f=cct:
MOBILE HOME RV PARK
Qnspccted���ith scrvice) _tJ of service or feedcr� 'Per�VAC 29G-46-910(5)(b)(i R ii)
Each outbuilding or gara�e...........................$57.00 (Pirst service/feeder-557.00;Add'n servicc/ _�o(Signs(First sign-�43.00;add'n sign
(Inspccted separatciy) feeder-$37 each) $20.00 each)
IS���imming pool,hot tub,spa............._$85.50 �
� Xard Pole meter loops._........ .....__._.�57.OG !
� �
� NEW MULTI-FAMILY COMMERCIAL/INDUSTRIAI COMMERCIAI/INDUSTRIAL i
� (I�cludcs threc units or morei Altcred Scn-ice or�ecders �
� Scrvice Pceder nmps �er��c�or Add'n _0 to 200......._.... ....._................_...i 93.UU i
Up to 2(N1 amp... ......._ S 93AG............._.$ 27.50 IFeeder _201 -600........... .........._._.....___..__.21�SG ;
201 -a00 amv_ .. __.... 115.SU..............._.57.00 _0 to 100.._..................._g 93.OG....._S 57.00 _601 -1000............_.. ..___..._.._.__...-.32650 i
` 901 -600 amp................158.50....................78.50 _101 -200........................ 1►5.50...........72.50 _�ver 1000.............................................363.Of,
I 501-800 am . 202.50.................. 108.50 201 -aOG.......................216.50...........$5.50 #of circuits i
p............... _ —
Ovcr 8W amp. ..............2P9.S0..................216.50 _4U1 -600...................... 252.50......... IOI.OG i I-5 circuits-$72.50;Add'n circuits,�6 eai
ALTERED SINGLE/MUITI FAMILY 601 -800........................326.SG.........138.00 �
(�Vhen inspected separa[ely from the services.) _801-1000......................399.00.........166.50 TEMPORARY SERVICE
Sen�ice or Feeder _Over 1000......................d34.50.........232.00 Residential/Multi-Famiiy/Commerciai/lndustrial
—0�0 200 amp...............................................$ 71.50 Over 600 volts surchazge......................72.SU U-100................................................g 57.00 I
20►-60U amp.............................................. ►15.50 _Mast or meter repair..................----........78.50 _IOI-200................................................72.SC I
ovcr60Uamp...._........_............................... f74.U0 20i -400..................__....._.._........._.._a�.50
Mast or meter repair ....................._........--....43.OU 40I -600.................._...................._....1 I iSU i
� a oi circuits over 60U.............__.........._..__.._.._....125A0 i
i i1+clrcuits-$57.00;Add'n circuits$6 ea)
. If a new•or altcrcd commercial service is 200 amps or greatcr,or a ne���or altered residential service is greater than 400 amps,a plan revicw is required.Fee is 3�%of
nermit fee+$72.50.Add'1 plan revie��-for other submissions is$85.50/hr.
FIXTURE DESCRIPTION A FIXTURE FEE FROM TABLE B B > NUMBER OF UNITS C TOTAL D I
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i
� `TOTAL COLUMN(D): � !
Total Colum�(D)
Estimated Permit Fee: (12)
Estimated�ermit Fee from G�e 12
Estimated Plan Review Fee: $72.50+( - X 35) _ (13)
� • .
Estimated Permit Fee: (14)
Bond Amount:(15)
Estimated Permit Fee:(16)
Bond Amount: (17)
•
Mitigation Fee: (18) (20) (22)
SBCC Surcharge: (19) (21) (23)
TOtal �ra9eso�,e&rWo): Line(s)(11)+(12)+(13)+(14)+(15)+(16)+(17)+(18)+(19)+(20)+(21)+(22)+(23) _ (24) �
Bulletin A 100—December 23,2002
� .
' ` � ,' '�' � ` # R $��: $�E ATT�CHED COVER LET # Activit Number
� ' Health, �e��l-e and King�ounty
�������ite�Design Application Form for Individuol On—Site Sewoge System (OSS) �N� a
mit 5 copies of application with 4 copies of plans� e artmen se n
OCT � 4 2� ATTACH A DETAILED ROUTE
ApProXunate
s�:e DIRECTION MAP FOR LOCRTI G
��TB��p Gp � _ 04 48TH AVENUE SW THE PROPERTY
Nam dress of property ownw � ANATOLY GORBUN - 13115 111TH AVE. CT. E., PUYALLUP, WA 98374 �
Applicant Street Address I 13115 1111H AVE. CT. E �
Name GORBUN ANATOLY � City-Zip Code I PUYALLUP, WA 98374 I Phone I 253-529-0616 I
Last Frst
Desi ner � ANDERSON DESIGN CONSULTANTS INC.� Street Address 3401 12TH STREET EAST
9 City-Zip Code L FIFE, WA 98424 I Phone 0- 24
THIS IS NOT A PERMIT
PROPERTY INFORMATION: Legal Description Attached I—�
Parcel # (APN) 184080-0015 Section: L 1J Township: L?1NJ Range: I 3E I
Subdivision Name: � CRESTVIEW SHORECLUB I Lot: L 3 J Block: ��
Property Size: I 14,637 I sq. ft. Acreage: I 0.33 I Rural Area LJ Urban Area �J
Distance from property line to nearest sewer: I 5 0 0 + I ft.
Water Supply �PJ (IP)I = Individual P = Public(More than One Connection) U Group A Supply L� Group B Supply
Public Water Supply Name: I TACOMA WATR I ID� I I
Sensitive Area: l N 1 (Y?N) If yes, specify I—I (L,W,O) (L = Landslide W = Wetlands 0 = Other)
SYSTEM INFORMATION:
New System L XJ Repair Design L—I Correction of OSS Failure?I N I (Y/N) Detailed Plons Attached: (4 sets) I Y I (Y/N)
Type of Buildiny I SF I SF= Single Famly �IF= Multiple Famly CON�I = Commercial INST= Institutiond
Type of System Proposed: L�—�P� G= Gravity GP = Gravity with pump �I =�lound
PD = rressure Distrbution SF= Sand F�ter HT= Hdd'mg Tank CT= Composting Tolet E = Experimentd 0=Othe�
Date Soils Lc�gged: I 03-13-03 I Soil Logs Data Attached: (�in. 4/lot) I 1'J (Y/N)
Depth to Watertable or Restrictive Layer: UJ inches Maximum Slope in Drainfield/Reserve Area: L.0 �
CALCULATIONS: �
Number of Bedrooms I 3 I Total Gallons/Day (450 minimum): I 450 I 9a1. Sol Texture Type (1A-5):L�l I
;:pF:;�t�es; Rate; -�J gal jsq ft/day Total ��serpti�,� �rea: � 7Fn ! sq. ;t. Tr�nch IYdth !3J i�ches �
";atal Drainfield Length: 250 ft. Septic Tank �ize: I 750 I ga1, Garbage Grinder LN I (Y/N) �
Pump Ctiember Size (if needed) I 1000 I gal. Trench Depth (min/maz): UJ /U inches
I understand lhat foilure to comply Code in unty Boord of Health Tille 13 may result in the disapprovol of the sewage system being praposed in Ihis
opplicafion. Non—compliance ead esi ti(icate of Competency and/or appropriale legol action by the Heolth Department.
Cesigner's Signature: W.S.LIC� I 5 � O O � O 3 I Date 09-09-03
FOR HEALTH DEPARTMENT USE ONLY SYSIEM MUST BE INSTALLED BY A KING
COUNTY CERTIFlED INSTALLER UNLESS
APPROVED � ,.�"d3 BY: . 0 Ef�IN E PR DED BY CODE
date H Lr�
Comments/Conditions: �c- J�
.
Pre- onstruction meeting required between designer, insta er, builder pria to permit issuance
APPRO'JAL OF THIS DESIGN APPLICATION IS BASED SOLELY ON INFORMATION PROVIDED IN THIS APPLICATION AND DOES NOT CONSTITUTE PERMISSION TO BEGIN
CONSTRUCTION OF 1HE PROPOSED SEWAGE DISPOSAL SYSTEM OR ANY OTNER IMPR0I�I�ENTS ON THE SITE. THIS APPROVAL SHALL NOT BE CONSIDERED AN
ASSURANCE, EITHER EXPRESSED OR IMPLIED, THAT DEVELOPh1ENT PERMITS FOR THE SITE W11C BE ISSUED. � ,,,�,���
THIS APPLICATION EXPIRES TWO YEARS FR0�1 DA1E OF APPROVAL. �
DISAPPROVED BY� SEP 12 2003
See attached Site Deficiency Sheet S7'GATE �UBLIC HEAL
My person aggrrieved by any decisian a find ader of ihe Health O(Gcer moy fde a written applicatiai fa appeal to hedth afticu within 60 colendar
doys of the dote o(the obore deasia�. (rtle 13,K.C.B.O.H.Chapte�13.12— Sewage Reaew Canmittee).N/tams/sewage/fam.99.CS 13.15.97
WHITE- DISiRICT/GREEN - AUDIT/YELLOW- DESIGNER/PINK- OWNER/7flLOW- UCEWSES dc PERMITS CS 13.15.97 REV. 08-04-99
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; � ->-�-i1CHTUNE V- WATER LINE
LEGEND — � ^
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a--�-1RANSPORT PIPE -P- ELEC1RICA1 UNE . �V: f -- PROJECT
_ � _ , '�-�' SIlF
-�--�►-IAlERAI iRANSPORT PIPE �- ClF1+N0UT
3 SW 310iH ST
----PRIl�ARY DRNNFlQD 1RENCH Qa PU�IP TANK _ ^, ¢
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. ----RESERVE DRNNFlELD TRENCN O � SEPTIC TANK .� -�� ��,,� � - �
----PROPERTY UNE __..
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. :' : �� I 150.00, '� . -- � � (J
� -� GRAPHIC SCALE �,,, � EX1S11NG �o' FOUNDATION � A P P,1R�0 � Sa..hs
BM. EL. 98.0 ASSUMED A Nr-
SNAl10W DITCH TO DRAINFlELD 36" fIR � l��
- 1� = 20' yp,"�.��� TO BE BACKFll1F0 SEIBACK L1NE l� P�I�-C�� CITY l7F
10 0 10 20 � PRIOR TO INSTAl1ATlON �� � PUBLIC �"'� + PU�U
� BY. � �%�rure.� — W�(L
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�: � 1 OF 6
�'Ne ANDERSON 3401 12TH STREET EAST ON-SITE SEWAGE PROJECT — SHEET.
`�� SYSTEM DESIGN 31�4 48TH AVE SW DATE: 09-13-03
�� ��•� ��� FIFE, WA 98424
� ':�� CON�T^"T� SEATTLE 253.850.3242 FIDERAL WAY 98023
�� 0 ANOERSON'•. FOR: ANATOLY GORBUN —
. �N�- TACOAIA 253.568.0999
���LICENSED�DESIGNER� FAX 253.927.1006 �3��5 ���� A�. CT. E —
., ;
EXPIRES o6/02/04 /��L'� www.adcaifo.can PUYALLUP WA 98374 PARCEL 184080-0015 N0. DA1E BY CK'D APP'D REVISION JOB :203285
, i
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O King County This ce._...cate provides the Seattle King
DDES County Department of Public Health and
the Department of Development and
DEPARTMENT OF DEVELOPMENT AND Environmental Services with information
necessary to evaluate development
ENVIRONMENTAL SERVICES proposals.
900 Oakesdale Avenue Southwest
Renton, Wa 98055-1219 FFo� Please return to DDES at the address
at the left.
King County Certificate of Water Availability
Do not write in this box
number name
❑ Building Permit ❑ Preliminary Pl�t or p!�D
❑ Short Subdivision ❑ Rezone or other
Applicant's name:
Proposed use: � 1 (� J
Location: �I�iC�y ��� �� � '1�-�t� ���-1C�}� -��a 1--�
(attach map and legal description if necessary)
. . . .
. - . ,i
1. � a. Water will be provided by service connection only to an existing `� (size)water main that
is ' t feet from the site.
OR
❑ b. Water service will require an improvement to the water system of:
❑ (1) feet of water main to reach the site; and/or
❑ (2) The construction of a distribution system on the site; and/or
❑ (3) Other(describe) ___ _
2. � a. The water system is in conformance with a County approved water comprehensive plan.
OR
❑ b. The water system improvement will require a water comprehensive plan amendment.
3. C�' a. The proposed project is within the corporate limits of the district, or has been granted Boundary
Review Board approval for extension of service outside the district or city, or is within the County
approved service area of a private water purveyor.
OR
❑ b. Annnexation or BRB approval will be necessary to provide service.
4. t� a. Water is/or will be available at the rate of flow and duration indicated below at no less than 20 psi
measured at the nearest fire hydrant ,'��G ' ''- feet from the building/property (or as marked on
the attached map):
Rate of flow Duration
❑ less than 500 gpm (approx. gpm) ❑ less than 1 hour
❑ 500 to 999 gpm ❑ 1 hour to 2 hours
� 1000 gpm or more � 2 hours or more
❑ flow test of gpm ❑ other
❑ calculation of gpm
(Note: Commercial building permits require flow test or calculation.)
OR
❑ b. Water system is not capable of providing fire flow.
Comments/conditions: The reauirements of Kinq Countv Ordinance 5828, pertaininq to fire code
requlations must be adhered to. The abilitv to provide service is dependent on riqht of wav permit
approval, to include applicable fees and anv special requirements as contained in the permit.
i certify that the above water purveyor information is true. This certification shall be valid for one year
from date of signature.
Tacoma Water Cind Beardsle
Agency name igna name C7'J `��
Utilitv Services Rep I ,
Title i a ure Date
FORMSBSD98-3 Revised 4/13/98 cic
(formerly form number F 278)