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":IICAT[ NO. PERMIT NO. Address As above Phone ?m Address . XX Phone XX Address 35717 Pacific Highway S. ehone ., 838,-3434 Address roc Phone 5accurate rep setliatw the ystem installed at the listed address. I further elevations, intena of gr es, fills, surface drains, etc.) listed by me on my a h e hr^;.-ornplied with. I further certify that this system me Du 0►4u o. 2?6'iz c- City of Seattle Ordinance No. 90181 whichever i TO BE FILLED IN BY HEALTH DEPARTMENT ONLY pted Date Not Accepted of Sanitarian C _a►�af• TIONS: You may use the reverse side of this form for the drawing or attach separate sheet. Use a scale which will permit the greatest detail and still contain the entire site on one page. ATTENTION HOME OWNER: is tack has !imitations! It was designed and installed to care for an average -size tamily. Overloading the septic tank or disturbance of the drainfield usly impair satisfactory operation. Points to remember: Have your tank checked periodically to see if pumping is necessary (2V2.3 years). Do not channel ground water, surface water, footing drains or downspouts into the tank or drainfield. Do not excavate, fill, place a structure, driveway or patio in, on, or over the drainfield. Limit toilet fixture disposal to sanitary wastes and toilet tissue. Detergents and bleaches used in normal household quantities will not harm the action of the septic tank and disposal field. SFAI'LE-Ki1r: Cnu%-v DEPr.n1Ur�- of )oLic HCAL'IH DIVISION OF ENVIRONMENTAL HEALTH SERVICES RO^» POa, PL P- 5ArETr 9111, OiNG SITE APPLICATION F0. INDIVIDUAL SEWAGE DISPOSAL SYSTFM (Sui)nit in Oti;idruplicalt•' (Tins, accompanies ,he building permit applicalinn and is prorequisite to the issuance or the Individual Sewage Disposal S,vSterrt Permit.) %'OTE: If lho prope-ty is within the boundaries of an operatinq sewer district or othr`r sewering au'honty, it will he neces- sary to obtain written permission from that tnithority allowing use of :ut individuil sp%vage disposal system. Loca:ion of Property—Siroct ,^.ddress i.- Addition or Subdivision _— Lot —Block 'Or attach legal description' Tvper of Building: New °_: Single Family Residrmcn. i (No. Bedrooms 7 ) Existing i-' Other i (Specify) North End 1600 N.E. 150111 98155 363-4765 Ecstside 15607 N.E. Bellevue -Redmond Road, Belli. rf? PF004 885.1278 or 747-1760 Southeast A.3001 N.E. 41h Street, Renton 98055 jt��'� 228-2620 Southwest 10321 °th S.iN. 9i14G=` 244-6400 Central 2120 1st North 98101-1 583-44.10 revt Address_ Owner ■ �*� City -Zip Code ^Phone_ Strec+.l Address— Builder — City 7.ip Code ?hone Street Addrr'ss I?•-3 D�•signer City -Zip Code-c,'.`: r' . _ Phone � = SoilLogTestsIDescribesoils(nCounteredprefer I t�3yhyFHA'Suniformsoil classification sysiem.)Minimum depth 48inches` Orr H 0 1 e No. 1 Yw3Lr. h i �i" + + 1 .. Hole No. 2_r.. ,' fir, ZL aA.Lf.�_ No. 31 rL:-:-... �' - ale-�`t.• sue./�t„,,. �r/��_� • �C}:� Hole+ No. 4 ' Evidence of Water Table, if encountered. (Distance from ground surficc) Solace of Domestic Plater Supply— '? . r _-.., r P-rcolation Tests (Fall in minutes per inch, hottom 6 inches of rest hole) Hole No. 1 ti Hole No. 2 L=� :� /n .rye •r Tole No.•3 r Holt- No. 4 Hole Nu. 5 P..ole INC). 6 Length of Time Sdakei�,�►�+"``'`~� n' C'4lrati f n. ! . v •�', ;its C` :For additional -nr::;rrl. s�{rrcomm(rots allsrch letter in lnplir_;itre or utilize unutirrrl spacers around drawing ona + =GF?rac Side of appl i•:.rt ion.) Siipi,iiuru- n. i!1ne} ! rf{� � . ,• � � _ 1 e�� _ . D s ,, ` • �•_ �� Dare—_ ..., DO N'OT ':'RITE BELO'ir' THIS LINE i i:, Iw fi11, 1 tri I i I!• ,�'ti, D^p•irinn nr. IDislriCt QIfiC�' ate' rrl,r✓�i a 3oo.3a /aeo•33 I�,v PGv` Z 00 °'�V35 003510 a()o . 10 � ot°°qaoo.3� /20S3 v $ I 30.36 (R) —SW- 342 N D- fl85•DI sGW 20G.IG 41 � _ 94 m, ltl y'- gB 11r R R52S ZjQ TR. 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L39 22 23 Ze7. 6-7 24 9' �y Zo4.5 6 � PG Z 5 0lp 2 5 O m G to cD cD co N 0 1 z ;I - CV PLEASE PRINT SI City of Federal Way APPLICATION FOR BUILDING PERMIT ��APPLICATION #: f� u,J` " 3 TE LOCAT ION Address Tenant (if known) Lot # Assessor's Tax # k 3v 7 von Building Owner Name Address City State Zip Phone Nature of Work APPLICANT Name (F,M,L) APPLICANT Name (F,M,L) Address V (TcR;- City E W State WI9 Zip gC),—t,3 Contact Person U Day Phe on M 6 i Other Phone L/9 c- 0(0 Fax BUILDING CONTRACTOR Company Name Address City State Zip Contact Person Phone Fax Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No ARCHITECT Name Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION 16, IS DUO Please Complete Reverse Side CD0492 (Rev 4/93) STRUCTURE Permit includes: ' 'sting Use ❑ Building ❑ Plumbing oposed Use ❑ Mechanical ❑ Other Type of Work: ❑ ❑ Residential Commercial ❑ New ❑ Addition ❑ Remodel ❑ Garage ❑ Number of Units ❑ Shed ❑ ❑ Deck Other Enter 1 at Floor C C'C. I sq ft Area Basement sq ft 2nd Floor Decks sq ft 3rd Floor sq ft sq ft Garage sq ft Existing Floor Area Proposed Total Area sq ft sq ft Water Availability ❑ Sewer Availability ❑ On -Site Septic System Availability ❑ Project Valuation s Zoning Lot Size Existing Bldg Valuation S LENDER Name Address City State Zip rVIECIUNICAL CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PLUMBING CONTRACTOR Contractor Name Address City State Zip Contact Phone Fax License # Expiration Date Verified ❑ Yes ❑ No PLUMBING FIXTURE COUNT Water Closets Sinks Urinals Lawn Sprinklers Bathtubs Dish Washers Drinking Fountains Other Showers Electric Water Heaters Sumps Lavatories Washing Machine Drains Total Fixture Count nmEmANICAL UNIT cvuNT 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 Miscellaneous Fuel Tanks Gas Hwt Hood Boilers Above Ground Conv Burner Duct Work 0-3 Tons Underground BBQ's Wood Stoves 3-15 Tons Total Unit Count 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, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this application. Owner/Agent: IJ �fl/�4 bale: PLEASE PRINT S City of Federal Way �wj►��EF;iLICATION FOR BUILDING PERMIT J U L 2 9 1993 APPLICATION #: � _, 0 `7.j O k?,3 TTE LOCATION Address r � Fe V4 ;t S Tenant (if -known) Lot # Assessor's Tax # I cL Building Owner Name 2 Address C � City State LL� 4 Zip �j , c5 L i Phone ,- 3 y f 3 C> Nature of Work yj) fm-/C 13-(?/5,1-a- r ,tea I- C A6 A/1-4 6 C'- PL Name (F,M,L) 57-/-'-1/e_^�) IOU Address )v Person CitracCont,t FEEL 21 Z CLJA - State � /f zip � eO Z �P/{/�� Day Phone Oth/er Phone 7 Fax i#irII.DING CONTRACTOR Company Name Address ' City State Zip Contact Person Phone Fax Contractor's 11 (card must be presented) Expiration Date Verified ❑ Yes ❑ No ARCITITECT Name / Z✓ mil) Zr" �� Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION I Please Complete Reverse Side CD0492 (Rev 4/931 PL Name (F,M,L) 57-/-'-1/e_^�) IOU Address )v Person CitracCont,t FEEL 21 Z CLJA - State � /f zip � eO Z �P/{/�� Day Phone Oth/er Phone 7 Fax i#irII.DING CONTRACTOR Company Name Address ' City State Zip Contact Person Phone Fax Contractor's 11 (card must be presented) Expiration Date Verified ❑ Yes ❑ No ARCITITECT Name / Z✓ mil) Zr" �� Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION I Please Complete Reverse Side CD0492 (Rev 4/931 i#irII.DING CONTRACTOR Company Name Address ' City State Zip Contact Person Phone Fax Contractor's 11 (card must be presented) Expiration Date Verified ❑ Yes ❑ No ARCITITECT Name / Z✓ mil) Zr" �� Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION I Please Complete Reverse Side CD0492 (Rev 4/931 ARCITITECT Name / Z✓ mil) Zr" �� Address City State Zip Contact Person Phone Fax LEGAL DESCRIPTION I Please Complete Reverse Side CD0492 (Rev 4/931 LEGAL DESCRIPTION I Please Complete Reverse Side CD0492 (Rev 4/931 S_ .IZUCTURE Existing Use C,/< Permit includes: 14 Building ® Plumbing Type of Work: 0 Residential ❑ New Remodel ❑ Commercial ❑ Addition Garage Enter 1 st Floor /.3 ;' t1 sq ft ' t��"/ 2nd Floor sq ft 3rd Floor sq ft Area Basement sq ft Decks sq ft Garage S 7f sq ft Water Availability in Sewer Availability On -Site Septic System Availability ❑ Zoning --` % — Lot Size /?its CLC^ I_. 'MECHANICAL:. CONTRACTOR Contractor Name City Contact License # PLUMBING CONTRACTOR Contractor Name City Contact PLUMING FLYTURE COUNT Proposed Use 0 Mechanical ❑ Other ❑ Number of Units ❑ Deck ❑ Shed ❑ Other Existing Floor Area / D S- sq ft Proposed Total Area sq ft Project Valuation 1 8 ;� 7� v Existing Bldg Valuation Address State Phone Expiration Date Address State Phone Expiration Date Water Closets Sinks 1 Urinals Bathtubs Dish Washers Drinking Fountains Showers Electric Water Heaters Sumps Lavatories Washing Machine / Drains MECHANICAL UNIT' .COUNT ... Fuel Type (electric/other) 5 Gas Dryer Air Handling < = 10,000 CFM Length of Gas Piping --7 - ' Range Air Handling > = 10,000 CFM Furn <100K BTUs Gas Log Unit Heater Furn > 100 BTUs Fans Miscellaneous Gas Hwt Hood Boilers Conv Burner Duct Work 0-3 Tons BBO's Wood Stoves 3-15 Tons Zip Fax Verified ❑ Yes ❑ No Zip Fax Verified ❑ Yes ❑ No Lawn Sprinklers Other Total Fixture Count 15-30 Tons 30-50 Tons 50+ Tons Fuel Tanks Above Ground Underground Total Unit Count 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 defe�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 raliano6 of the City, including its officers and employees, upon the accuracy of the information supplied to the City as a part of this application. Owner/Agent: ✓� Date- SEA tHQ COl1NTY DEPARTMENT OF PUBLIC HEALTH J U L 29 1993ENVIRCH ENTAL HEALTH SERVICES Total Fee: $75.00 fr.�7s'if li APPLICATION FOR HEALTH DEPARTMENT Rr',II1 rlUV7,37 APPROVAL OF BUILDING PERMIT Submit application, route map, building permit plot plans, and other required documents in triplicate. The following must be completed and the fee must accompany this application: Note: If the property is located in unincorporated King County, make direct application to the King County Building and Land Development Division (B.A.L.D.). Properties in incorporated cities apply to local building departments. PROPERTY INFORMATION �_o R_ � A) � &111111 j 7 [2j House/structure is served by an on -site sewage (septic) system O �� y Distance to the nearest public sewer r Address of property `� S FF D Z.3 Parcel Number (Tax Lot Account #) �� j ('� lJ U . S C✓ , Applicant's name 1Yn )(ZDay Phone_ 3 3�C / 3 c: Applicant's mailing address 5 S ,S -� ` � S r- , - F - L) to-n, Z3 Owner's name Day Phone Age of house .+5 Number of existing bedrooms Existing square footage of house-_/ 7 Are additional bedrooms being constructed or created? Description of proposed changes/remodeling (attach plot plans, showing existing structure, remodeling and septic system); — - - AD L) 6 12/ C't.J 4 � ,✓ � r .,�, �, New square footage after construction _ ~ c,� NJ . : A c S� FT SEWAGE SYSTEM INFORMATION �' %c.- Approximate dates septic tank was pumped (attached receipts) Additions or major landscape changes since house was constructed (examples: add Tamil room, bed- rooms, garage, patio, deck, pool, etc.; major fills or excavations done in landscaping: P,.l- Iv e Additions or repairs to sewage system (give date and describe briefly) Other information which would be helpful In evaluating the sewage system (le. drainfield easements, covenants, etc.): WATER SUPPLY INFO MTIOR [� Public system (2 or more connections) Private (well, spring, etc.) Attach copies of well log, well Name of Public Supply covenants, chemical/bacteriological sample reports FOR HEALTH DEPARTMENT USE ONLY 0 APPROVED BY: Date DISAPPROVED BY: Date Comments/Conditions: e Any person aggrieved by any decision or final order of the Health Officer may make written application for appeal to the King County Board of Sewage Review if done so within 60 days of the above decision. /hd/svw3go/ forms/form37/fr-3-91 APPLICANT The following must be included with your application: Provide an accurate route reap and directions for locating the property, including color of building (house, garage, etc.) Three copies of a completed Health Department Application form Application review fee $ 75.00. Three copies of your building permit application (i.e,. from the City Building or Land Use department).. Three'copies'of the scared plot plan of the project. Show location of on -site sewage system, well, spring, easements, etc. Copies of easements, covenants or other records pertaining to sewage disposal or water supply -111093 �()M F/w lkr?,L�D` 31- 0933 -This certificate provides the Please return to: Department of health and BUILDING & LAND DEVELOPMENT Dui 1 d i n g & Land Development Parks, Planning & Resources Dept. with information necessary to ' 3600 - 136th PLACE Southeast evaluate development proposals. Bellevue, Washington 98006Uj 400 (206) 296-6600 4- .0 - AVAILABILITY L �' � KING COUNTY CERTIFICATE Or SEWER -e box o C Uo no wr 1 11) 15 U W number � name O �L«- jg Uuilding Permit ❑ preliminaryPI.�L' or PUU Q'� � ❑ Short Subdivision ❑ Rezone or other (D U APPLICANTS NAME 1Z Q U �t �r USE �s (D O5 ..� PROPOSED ,_ V E LOCATION 5 5 - 4 3 3 - :3 O �� I Of �� 4:L I z- � l�m .-L011-5� (Attach map & legal description if necessary) p� H> N H N N II 11 II 11 II R 8 it n .c LL Q Y SEWER AGENCY INFORMATION e--A /V 1. a.J Sewer service v*-1� be provided by side sewer connection only to an existing size sewer 3,0 0 feet from the site and tho sewer 'system has the capacity to serve the proposed use. OR b. Sewer service will require an improvement to the sewer system of: ❑ (1) feet of sewer trunk or latteral to reach thu site; and/or ❑ (2) the construction of a collectioli system on the site; and/or ❑ (3) other (descr°.be)