04-102148 RECEIVEDri COMMUN IYDEVELOPMENTSERVICES
III33530 FIRST WAY SOUTH•PO BOX 9718
ctr a of 4411111,... , FEDERAL WAY,WA 98063-9718 J,.
Federal Way,�N 0 1 2004 PERMIT APPLICATION 253-6614115•FAX.25366/-4/29 •v\^
www.citynffedernlwoy.mm A
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For OBi<e U.Only —
FW File Num'tSer: / /
The ollowin• is re.uired in ormation-an incom•lete a.•Iication will not be acce.ted. Please •rint le.ibl (in ink)or •
-‘--•• '---111 PROPERTY INFORMATION . . -4:
SITE ADDRESS: Z/c-5 / " 74/€-. . ��, SUITE/APT# -3--
ASSESSOR'S TAX/PARCEL#: 2 oR C0, - Q0/.D SQUARE FOOTAGE OF LOT:
L i • DESCRIPTION (e.g.:Acme Estates,Lot 1)
(Attach separate page for lengthy legal description)
■ PROJECT INFORMATION
TYPE OF PERMIT(This application): BUILDING PLUMBING ❑ MECHANICAL 0 DEMOLITION
0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlq): , '/-'7 "CCC /njr l
_l G'!- U.e-e.. t-Ga CT." rG-„, , /-.a,4 C. GC x7/c.-d-riepe- `Q
+ '.e..r '.c-camS- ..
PROJECT NAME(Name of Business/Owner Last Name): if-,--c 1�,P7 z-.�- £ Gr'-t'- j,Pte`' -,c7CA.,/ -
. • PEOPLE INFORMATION
PROPERTY NAME: C PRIMARYVPHONE:
OWNER SD �( Oct1 cO 0f• . Cc r".-1� Gr�Ptr.'RI 4j - f°' roo47
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
%a 216.' M . o.41413.5- r eJ erk1 () !L'JA ijiaj
CONTRACTOR NAME COMPANY OFFICE PHONE:
tr-"*715-16415/21, � / COJ /r-c (Z 3) S65^-06_5-y
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP CELL PHONE:
7.3,.. "
5C,/.-pea C. --- )4/? -e.%(7 . �'/ sp 2 `10 7(z53) -6 -8.3�jv
CITY OF FEDERAL WAYBUSINESS LICENSE NUMBER: EXPIRATION DATE: FAX NUMBER: .✓
2v - X51- / C.'/ z3- cpb—oL „/...2../3/ /Of (45-3 )S6,` /5L '
CONTRACTOR'S REGISTRATION NUMBER: �j EXPIRATION DATE:
(copy of card required with each application) 5 4_'✓�L L* C] b/ T' / 4) / -z.,/ /os/
LENDER ----',, NAME: DAYTIME PHONE:
(Ir Proposed Value s f5,�)
l 1
MAILING ADDRESS(STREET ADDRESS;): CITY,STATE,ZIP
APPLICANT- NAME: COMPANY OFFICE PHONE:
' 1c,.,-,'i 4__ a. c€c 5/e_C c>. , /,-, . (2-5-.. ),..,C,7” - C63-1/
MAILING ADDRESS(STREET ADDRESS): CITY,STATE,ZIP EVENING PHONE:
735-U C,/-yeZ-7,-. <kl. _CG97i v, ' 414 26%7 ( .5:5)5:6_5—- 2-//1.__
RELATIONSHIP TO PROJECT: P FAX NUMBER:
❑ Architect o Tenant Other(Describer pee,c,---,/c- 0;47)21-9,e4.--- ( 3 -039z)
CONTACT PERSON FOR THIS PROJECT: 0 Property Owner (Contractor ❑ Applicant E-MAIL ADD
IN DETAILED BUILDING INFORMATION •
' "
EXISTING USE: /Z'� � GC-� PROPOSED USE: — /�0-457?--C- --
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ /
-. /'c._... ...
SPRINKLERED BUILDING? ❑ YES XNO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: 0 YES ›Fr NO
WATER SERVICE PROVIDER LAKEHAVEN 0 HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER )<LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• ■ PROJECT FLOOR AREAS •
AREA DESCRIPTIO• EXISTING SQ.FT. PR♦ -SED SQ.FT. TOTAL
BASEMENT
FIRST Z�JB C>8
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE)
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS? TOTAL EXISTING TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ V —
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS 3 FANS HOODS(commer<at) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe) •
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING •
BATHTUBS(or Tub/Shower Combo) SHOWERS / WATER CLOSETS(toilet) MISC(Describe)
DISHWASHERS / SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(n m oom sink 7 VACUUM BREAKERS ELECTRIC WATER HEATERS
. ■ DISCLAIMER/SIGNATURE BLOCK
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 the permit
application is made. I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and
attorneys'fees incurred in the 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 itss officers and employees, upon the accuracy of the information supplied to the city as a part of this application.
NAME/TITIN:. _. . DATE: ��j��
(Signature)nature) s!/%2L (Titled
RELATIONSHIP TO PROJECT: 0 Property Owner ❑ Applicant 'Contractor U Architect ❑
FOR OFFICE USE ONLY:
o NEW a ADDITION o ALTERATION ❑REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION: CHANGE OF USE? o YES ❑NO
NEW ADDRESS REQUIRED? ❑YES a NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? ❑YES o NO DEMO PERMIT REQUIRED? a YES ❑NO
Pagc 2
City°r Federal Way ;, uilding - Commercial Permit #: 04 - 102148 - 00 - CO
Community Development Services
33530 i st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: MACKENZIE& GREENFIELD DENTAL
Project Address: 32105 1ST AVE S SuiteB-5 Parcel Number:926502 0020
Project Description: TI- Minor framing,drywall,coustical ceiling,relocated plumbing fixtures
Owner Applicant Contractor Lender
SDGJ ASSOCIATES SAFFLE CO,INC.*DEAN SAFFLE* SAFFLE CO,INC.*DEAN SAFFLE* NONE
SDGJ ASSOCIATES SAFFLE CO,INC. SAFFLC*001P1 10/21/04
32105 1ST AVE S SUITE B-5 7350 CIRQUE DRN SAFFLE CO,INC.
FEDERAL WAY WA UNIVERSITY PLACE WA 98467 7350 CIRQUE DR N NONE
Includes:
Census category: 437-Comm #1 #2 L #3 #4
Occupancy Group: B
Constructon Type:
' i
L Type V-N -- -- -- �
1 Occupancy Load:
Floor Area(Sq.Ft.): H____ ffb
Census Category 437-Commercial alt/add Mechanical Yes
Number of Stories 1 Permit for Building Shell Only No
Plumbing Yes Zoning Designation BC
Plumbing Fixtures
I—
L
avat°ries Description Quantity;_ i Sinks1 —I � Description - -JlQuantityl Lva uttmBDescription reaklQuarslntityl
LPWater Closets 1
Mechanical Fixtures
Description _[Quantity] Description Quantity r Description Quantity]
-----Fans 1 2 -
I-
PERMIT EXPIRES November 28,2004.
Permit issued on June 1,2004
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 accordance with the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or at '
ellYZIg(4— Date: -6-/Ay-
INSPECTION LOG
DATE INSPECTOR OK CORR/REJ AREA AND TYPE OF INSPECTION
• THIS CARD IST MAIN ON-SITE .&
CITY OF v;, '
"`-:-= Community Developirtnt Inspection Record
Federal WayIVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-102148-00-CO
Owner: DEAN SAFFLE
Address: 32105 1ST AVE S Suite B-5
FEDERAL WAY, WA
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD.
Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections
are logged on the back of this card.
O Footings/Setback(4110) ❑ Foundation Wall(4115) 0 Drainage/Downspout (4040)
Approved to place concrete Approved to place concrete Approved to backfill
By Date By Date By Date
❑ Re-steel (4215) ❑ Plumbing Groundwork(4190) 0 Slab/Concrete Floor (4255)
Approved to place concrete or grout Approved to cover Approved to place concrete
By Date By Date By Date
❑ Underfloor Framing(4285) 0 Floor Sheathing (4105) ❑ Shear Walls (4245)
Approved to sheath floor Approved to install flooring Approved to install siding
By Date By Date By Date
❑ Roof Sheathing(4220) 0 Rough Plumbing (4230) 0 Mechanical Rough-in (4165)
Approved to install roofing Approved Approved
i` /d
By Date By Date 7�11 `/'''' By Date
❑ Gas Piping (4125) 0 Fire/Draft Stops (4095) NOTE: Prior to scheduling a Framing(4120)
Approved to release test Approved . inspection;Electrical,Plumbing&Mechanical
' Rough-in and Fire/Draft Stop inspections must be
By Date By Date hsigned-off and approved. IBC 109.3.4/UBC 108.5.4 N. aa
'-:7
❑ Framing (4120) ❑ Insulation(4150) % Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard •pproved to install mud&tape
By Date 1 / 4• '�r By Date By G Date (2 -€)ElSu'spended Ceiling Grid (4265) ❑ Final-Fire Department(4060) ❑ Final-Planning(4070)
Approved to drop tile Approved Approved
By Cc....A.D Date-1_22.o 4 By Date By Date
•
❑ Final-Public Works (4080) ❑ Final-Mechanical(4065) ❑ Final-Plumbing(4075)
Approved Approved Approved
By Date By Date By Date
❑ Final-Building (4050)
Approved
By Date