20-102296-SF-Certificate of Water and Sewer Availability-06-14-2020-v1�, Lakehave�n
31623 - 1st Avenue South * P.O. Box 4249 * Federal Way, WA 98063-4249
Telephone: 253-945-1580 or 253-945-1581 * Email: DE@Lakehaven.org
APPLICATION FOR CERTIFICATE OF AVAILABILITY (2020)
Jrl Water L�P Sewer (Check One or Both)
FEE(S) MUST BE PAID AT TIME OF APPLICATION (Check One only
PAYMENT BY CASH, CHECK OR CARD ACCEPTED
❑ Standard Certificate Fee = $80.00 each ($160.00 both), Max. 10 workday issue
® Accelerated Certificate Fee = $110.00 each ($220.00 both), Guaranteed 3 workday issue
IF SPECIAL FIRE FLOW INFORMATION REQUIRED FOR WATER CERTIFICATE, AN ADDITIONAL $240.00
WILL BE DUE UPON CERTIFICATE ISSUANCE
Applicant:
Kushal Kumar
Site Address: 9:1: 18th-•- 9:11
•t 2 - 367440 I • Lot 5 - 367440 I1-39 Lot i •
Tax Parcel #: I •t -1 — '367440 0137 Lot• — 367440 0140 Lnt• — 367440 0145
• • 441 0138 Lot 7 — 367440 0142
Purpose: (Check One) IFIBuilding Permit ❑ Subdivision ❑ Boundary Line Adjustment
❑ Binding Site Plan ❑ Other (specify)
Proposed Use: (Completion of Appropriate Section(s) REQUIRED)
Single -Family Residential (ATTACH SITE PLAN)
Non -Residential (ATTACH SITE PLAN)
Bldg. Use (be specific):
# of SFR Lots 8
Bldg. Sq. Ft. (including garage) 29,392
Bldg(s). Sq. Ft.
Bldg. Construction Type: ❑ IA or IB ❑ IIA or IIIA
ElIV or V-A ElIIB or IIIB ElV-B
Multi -Family Residential (ATTACH SITE PLAN)
# of MFR Buildings
Bldg(s). Sq. Ft. (including garages)
Estimated Water Use (gallons per year):
# of MFR Units
Domestic/Commercial
Recreation Buildings: # w/Pool
Irrigation
When Certificate is Prepared (select one)
mail to: Kushal Kumar ❑ Mail to:
kkgeneralcontractor@hotmail.com
cc: home@seattlehome.net
❑ Call for Pick-up:
NOTE: Lakehaven Water & Sewer District makes no representation that the Certificate(s) of Availability
will be accepted by local land use authorities.
(FOR STAFF USE ONLY)
CR#: CR DATE: GIS GRID:
Availability App-2020.docx (Form Update 12/26/19)
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