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PLEASE PRINT
BUILDING DIVM0N
33530 First Way South
Federal Way, WA 98003
(253) 661-4000
�e A Fax (253) 661-4129
AN 19 149q
APPLICATION FOR BUILDING PERMIT
APPLICATION #
Site address 7i () (�Alle
Tenant name
Lot #
Assessor's Tax #
Building Owner's Name I
�J
Address
l 2(5k lP SVv
City Fedeml LL4i�
State
zip Z
PhoneDescription
of Work 1 1-h
ligI
FA
APPLICANT... - -
Name (F,M,L) k
Address
/D U 12154 Ave SA/
Cit F
State
Zip3
Contact Person�/�
T (w la S l
Day Phone�3 �� _�
Other Phone
Fax
J
Ferieral Warm RiscinPcc Licence #
Company Name
Address O
CityP�L
State
zip '1 0.2—
Contact Person
flevu � k
Phone
� tip) 8 38 —13�i 3
Fax
h 64-
Contractor's # (card must be presented)
Expiration Date
Verified ❑ Yes ❑ No
Name r,
G
a k-e-(�
Address
U
-5' - Aw SW
Cit ep
cif
State
Zi v .7
Contact Person
y
Qi% M&
Phon
?�'3) —l3�
Fax
LEGAL DESCRIPTION
lease Com"I W Reverse Sid
g Proposed Use
�• Existing Use
Permit includes:
li� Building
17 Plumbing
❑ Mechanical
❑ Other
Type of Work:
Residential
❑ New
Remodel
❑ of bedrooms
❑ Deck
❑ Commercial
Addition
❑ Repair
Ef Gara e
❑ Shed
Enter 1st Floor
sq ft
2nd Floor 4_ �' sq ft
3rd Floor sq ft
Existing Floor Area 0 sq ft
Area Basement
sq ft
Decks sq ft
Garage sq ft
Proposed Total Area
ss ft
Water Availabili
Sewer Availability
❑ On -Site Septic System Availability 0'
Project Valuation
$ WOO
Zoning
Lot Size 16, (QC) S
" _
Existing Bldg Valuation
$ 02.1000
Contractor Name
Address
City
State
Zi
Contact
Phone
Fax
License #
Ex -,ration Date
Verified ❑ Yes ❑ No
----------------------
--------
00'.
Contractor Name
Address
City
State
Zip
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets Sinks, Urinals Lawn S rinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washin Machine Drains Total Fixture Count
;:�;.ryge•
-.-='..
MECHANICAL EVALUATION ONLY $
Fuel Type (as/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
Unit Heater
50+ Tons
Furn > 100 BTUs
Fans
Miscellaneous
Fuel Tanks
Gas Hwt
Hood
Boilers
1 Above Ground
Conv Burner
Duct Work
0-3 Tons
Under round
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
attomeys' 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 ofthe information supplied to the city as a part of this application.
Owner/Agent: �� Date: GAOL.
Bua Aw
R[v 5ED 511 B199
SEA __AE-KING COUNTY DEPARTMENT OF PUBLIC H> �TH l ,, r,q
ENVIRONMENTAL HEALTH 0
TOTAL FEE: 5125.00 APPLICATION FOR HEALTH DEPARTME
APPROVAL OF BUTT DING PERAm.
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 unincomorated King County, make direct application to the King County Department of Development and
Environmental Services. (DDES). i'roper:ies in incorporated cities apply to local building deparranerim o
PROPERTY INFORMATION
V**�House/Sumcture is served by an on -site sewage (septic) system
Distance to the nearest public sewer 1,6 Fe -et
Address of property 0 rb .2.1 S 7-1VdMt4F !;W Fe- PM --
Parcel Number (Tax Lot Account #)_ _. 26F,2 6 3 `J O 77 ' ]°
Applicant's Name Afu M a Jr Day Phone a53�
Applicant's mailing address
Owner's Name Pe ch to i- Day Phone(4,75) .g -1
Age of house 4,q Number of existing bedrooms 3 Existing square footage of house 4170
Are additional bedrooms being constructed or. created?
Description of proposed changes/remodeling (attach plot plans, showing existing structure, remodeling and septic system):
Affa( hod" �'r r p�..�.
v
'New square footage after construction
Approximate dates septic tank was pumped (attach receipts)
Additions or major landscape changes since house was constructed (examples: add family room, bedrooms, garage, patio, deck, pool, etc.; major
or excavations done in landscaping):
Additions or repairs to sewage system (give data and describe
Other information which would be helpful in evaluating the sewage system (i.e. drainfield easements, covenants, etc.
WATER SUPPLY INFORMATION
Public system ( 2 or more connections)
Name of public supply
APPROVED �3
Date
DISAPPROVED
Date
FOR HEALTH DEPARTMENT USE ONLY
c
SY:
BY:
Piny person aeaneved by any decision or Baal order of the Hcai i Utficer may maze written appacauon
for appeal to the King County Board of Sewage Review if done so within 60 days of the above decision.
Private (well, spring, etc.)
Attach copies of well log, well
covenants, chemical/bacterial
sample reports.
j Date Received
Y
F_ TG.
76
V
III
kA
Yu L I IS-9.9
EASTGA, i -L
",,.,JCE CENTEV
v rf-, �
DEPT. C"OutqTY
r- PU8L('C HEALTH
............
..............................................
................. ............................ ENG
6X. -,
L
Public Health and Seattl '.ing County `
Application for Health Department Approval of Building Permit Thomas Guide Page/Loc.
For houses or structures served by an on -site sewage (septic) system
East Public Health Center 14350 SE Eastgate Way For DDES use Only
(206) 296-4932 Application Fee: $210.00 D t R d
Please submit al2plication and all support documents in triplicate
The minimum support documents include:
1. detailed route map and directions to property
2. plot plan scaled at 1"=20' or 1"=30' 11 x 17 max. size, to include:
■ house footprint and any proposed changes to that footprint
• location of septic tank and pump tank, drainfield and all tight sewer lines
■ location of reserve drainfield area (repair area)
• all water lines and well sites, show 100ft radius around all well sites
■ location of all out buildings
location of all driveways and parking areas
■ all property boundaries and easements
• all streams and bodies of water
3. Floor plans of what is changing in the building 11 x 17 max. size.
a e e V %1
Tracking No.
Permit Tech
HD Fee Collected: Yes No
-H 0 j 0C
Property Information
Address of Prope-r0f21e�� &_ �W W _ W Lj}k Parcel No.
�appficants Name VT Day Phone 3 —
�� .p emts-Mafhq—Add ss X010 ?VP &SW . fll . 1,,IA- �50)3 _
Owners Name - Qeu ng Day Phone
Age of House 40 t Distance to nearest public sewer
Existing Square footage of house /4" f j _ - Number of existing bedrooms
Square footage to be added c.2 0 . _ Number of bedrooms being added 0
Description of proposed changes _A da drzzQ
Approximate dates septic tank was pumped (attach copy of receipts)
Additions or repairs to sewage system (give dates and describe briefly) AX
Describe or attach any drainfield easements or covenants which may impact the property
WateESupplv Information
Public water system (water supply with 2 of more connections)
Private (well, spring, etc.) attach copies of well log, well covenants, chemical/bacteriological sample
reports.
For Health Department Use, Only ❑ Released Initials Date b+ - ! C
Approved ? By
❑ Disapproved n;rlc y: "
'ETED
❑ Hold n:,re By:
Comments/Conditions: rRR!rr*u
MAR 2 3 2003
Eastgate
r
, Jjy 113ull aggi lute❑ ay ally ucL;naun or final uruer or me riezum vrncer may maze wnnen appncauon ror appeal to the &Ing county 25cwage [review
Committee if done so within 60 days of the above decision date.
Building Permit Application 12/99 version 4
APPROVED
SEATTLE-KING COUNTY
DEPT. OF PUBLIC IJEALTH
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APPROVED
SEATTLE-KING COUNTY
DEFT. OF PUBLIC HEALTH
DATE
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5E:rSAGKS & FOOTINGS
Date . �(j - By
34 i ;1 r
�. t` u "i
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t7
21
FOUNDATION WALLS 7
d� p `� J��Y]� ��} 1 hr"
1:7'�
Date _ / By 'i�)
3
PLUMBING GROUNDWORK
t"_
Date By
4
SLAB INSULATION
Date By
5
FOOTING/DOWNSPOUT DRAINS
Date By
6
UNDERFLOOR FRAMING
Date By
7
SHEAR WALLS
�j�.-i
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�PLUMBING ROUGH -IN
Date By
=GAsING
Date f.1 7-7,$Y
10
MECHANICAL. ROUGH -IN
Date Z By
7MRAMING�y4
4.4 s
Date(. BY
rv•s,
12
INSULATION
Date BY sS�u
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' 1.tc 2
13
GWB _ 1ST LAYER
e ! ,
LC.y
ir
Date �� By .S,S
14
GWB - 2ND LAYER
Date By
15
SUSPENDED CEILING
Date By
16
PLANNING FINAL
Date By
17
PUBLIC WORKS FINAL
Date By
18
FIRE FINAL
Date By
19
BUILDING FINAL
Date `02 7• 01 By..,4f"QC2_
20
OTHER
Date By
CDO193 (Rev 4/97)