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SET PIACKS AND FOOTINGS
DATE �BY _ iC/
OX TO POUR FOUNDATION WALLS
DATE i` BY
DATE.! Y/ BY A/%
PLUMBING ROUGH IN
DATE BY
WATER LINE O.K.
GAS PIPING O.K,__
-_
MECHANICAL INSPECTION
DATE _ _BY _
O.K. TO ENCLOSE FRAMING
DATE /d -/'( ' 91 BY
INSULATION
DATE�G' `LBY _
�IL
WALL BOARD AND FIRE WALL
DATE'-
FINAL O.K. TO OCCUPY
DATE JBY
DCD
PSD
FD
JAA
ReCEIVeD
JUL z 5 1991
Cffv BUILMNG 6E; rwAY
-'rmit
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION q I-10z��y
— Please Print —
BOX 1 TENANT NAME: 91
OWNER Bruce R. & Susann E. 2QaMpbell SITE LOCATION
OWNER'S ADDRESS 3024 SW 339th St. CITY Federal Way PHONE 838-8262
DESCRIBEJOB 320 sq.ft. aingle story family room addition and deck relocation
THE PROPERTY IS OWNED BY: SINGLE/MARRIED Married PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS
EXPIRATION DATE
Self
CITY
CONTRACTOR'S REG. #
Card MUST be presented
PHONE_
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON Bruce R. Campbell PHONE 251-8000
BOX 4 SEWER DISTRICT Federal Way WATER DISTRICT Tacoma
BOX 5 ESTIMATED PROJECT COST $6 00 00 EXISTING BUILDING VALUATION $86,500.00
BOX 6 PROPERTY TAX ACCOUNT NUMBER 873216-0150-08
LEGAL DESCRIPTION Lot 15, Tw'n La es Park, according o the plat thereof recorded in
61arid- 62 in King County,, WA.
(If necessary, please submit a separate page with the legal description.) �\ e i
K.C. Plat Recording # —— I�-L
�
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR 1200 / 1520 2ND FLOOR 700 / N/A
3RD FLOOR NZA / BASEMENT N/A DECK 300 / 300 GARAGE 320 /N A
BOX 8 ( X) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS = )
( ) COMMERCIAL/INDUSTRIAL
BOX 9 PLUMBING FIXTURES (including rough -ins)
NO. _ WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
—DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
0 TOTAL FIXTURES
( ) NEW CONSTRUCTION
( X) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY Approx. 10,350 SQ FT
MECHANICAL APPLIANCES — BASIC FEE $
GAS PIPING, FEET $
NO. FURNACE, ELEC. GAS $
GAS HOT WATER HEATER $
CONVERSION BURNER $
BOILER, SIZE BTU $
AIR HANDLING UNITS $
HEAT PUMPS, SIZE $
UNIT HEATERS ' ce ?AT-k $
___�1R COOLING UNITS, SIZE $
COMMERCIAL HOOD $
_�OTHER — $
TOTAL MECHANICAL FEE $
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 ASTO 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,.4JPDI THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE:
ANP-003 3/90
OFFIUr- USE ONLY (PLEASE DO NOT WRITE BELOW THIO LINE)
ZONERil?—� SETBACKS: FRONT 20' SIDE 4 REAR_ S i HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL 012MI
REMARKS: __
SEPA: EXEMPT V"' NOT EXEMPT
FIRE DEPARTMENT APPROVAL DA
REMARKS: —
NM
PUBLIC WORKS DEPARTMENT APPROVAL DATE g 9
REMARKS: ALL DDwtvSPOur$ .4/`NP Foorj-,14 P.42olin15 Syg1. G /3E' 7-14Mr���Eo To
�IPP�oy�� _ Srr�Rrot p¢Ra�.4��' sysr��
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL _ COMM. ADD/ALT NEW MULTIFAMILY (UNITS —
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY - _ TYPE OF CONSTRUCTION !) A STORES
BUILDING SO. FT. @ 7i . 2 z_
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @ -
_- BUILDING SO. FT. @ -
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @ A-0
TOTAL SQ. FT. TOTAL VALUATION 7-6-5 2�'. y
BUILDING DEPARTMENT REMARKS:
PERMIT FEE
Z( ,
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
P�
-�'S-a• as
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount _ Date
Receipt #
BUILDING DEPARTMENT APPROVAL
BY K'' DATE
ACCEPTED FOR FILING
I .-Mit # Mao
RECEIVED
AUG 2 9 1991 CITY OF FEDERAL WAY
cmvor- FEDERAL wAYBUILDING PERMIT APPLICATION 91-1ozos�
BUILDING DEPT. — Please Print —
BOX 1 TENANT NAME:
OWNER uC(' `iTE LOCATIOk foqL
OWNER'S ADDRESS CITY Wd G 1 L01XI PHONE, C-
DESCRIBE JOB r r 0. t) rc`•1 `• C_ ��V ���lv�
THE PROPERTY IS OWNED B : INGLE/MARRI D t"��r.{� V� _ PARTNE SHIP CORPORATION
BOX 2 CONTRACTOR'S NAME ` CONTRACTOR'S REG. #
Card MUST be presented
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE
—OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY CONTRACTORS AND
CHAPTER 18.27.110 WHICH PROHIBITS ISSUING PERMITS WITHOUT PROOF OF REGISTRATION.
BOX 3 CONTACT PERSON _V 12- LG f._3() 0 PHONE at)) _ $CCU
BOX 4 SEWER DISTRICT FuWATER DISTRICT i0L-coM0_
BOX 5 ESTIMATED PROJECT COST . ���� -0 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER -13- al e1 -
LEGAL DESCRIPTION LQ r I _ c
(If necessary, please submit a separate page with the le al description.) 1
K.C. Plat Recording # __ F'1-P(_ -rlC-
BOX 7 BUILDING SQUARE FOOTAGE- (Existing/Proposed) 1ST FLOOR i2.on 1 2ND FLOOR `7c' a�-
3RD FLOOR "-'0 --/ - BASEMENT " >- DECK 3_n 1 . GARAGE 3Q0 1 G�
BOX 8 (-,<:)- SINGLE FAMILY
( ) NEW CONSTRUCTION
[ j MULTIFAMILY (NO. OF UNITS = )
{ .:) EXISTING STRUCTURE
FT
( ) COMM ERCIAUINDUSTRIAL
TOTAL AREA OF PROPERTY A-%Di7f rcu
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
N0. WATERCLOSETS
GAS PIPING, FEET $
BATHTUBS
NO. FURNACE, ELEC. GAS $
SHOWERS
GAS HOT WATER HEATER $
LAVATORIES
CONVERSION BURNER $
SINKS
REVISIO
BOILER, SIZE BTU RECEIVE
DISHWASHERS
AIR HANDLING UNITS
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE AUG Z a
LAUNDRY WASHER OUTLET
:' .- UNIT HEATERS + .f'r. ;l,., s $
URINALS
AIR COOLING UNITS, SIZ$
DRINKING FOUNTAINS
COMMERCIAL HOOD
SUMPS, SPRINKLER VACUUM BREAKERS
OTHER $
DRAINS
`- lam[ c^+ ���i� r
OTHER
;'t- f^ L�_,� c $
C') TOTAL FIXTURES
$
TOTAL MECHANICAL FEE $
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 OFTHE 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:
DATE: 0 - q I
ANP-008 3/90
ZONE SETBACKS:FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE REAR HEIGHT LIMIT . I"
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADDIALT NEW MULTIFAMILY (UNITS, )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY TYPE OF CONSTRUCTION . STORES
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SO. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
I �-
:�a if;
REVEI G0
AUG 2 8 1991
(gV OF FEnERAL w
8UjLplNG i]EPT.
RECEIVED
ASSIGNED ADDRESS:
.l� r,
DATE— -
DA
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES -
AMOUNT DUE
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date , Receipt #
BUILDING DEPARTMENT APPROVAL r
3Y ..DATE
1
ACCEPTED FOR FILING
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