04-101800City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003 -6210
Ph: 253.661.4000 Fax: 253.661.4129
Project Name: BLEVENS
9 0
Building - Single Family Permit #: 04 - 101800 - 00 - SF
Project Address: 4151 SW 314TH ST
Project Description: Replacing cedar to comp roof
Inspection request line: 253.835.3050
Parcel Number: 873199 0590
Owner
Applicant
Contractor
Lender
GARY BLEVENS
GARY BLEVENS
GARY BLEVENS
NONE
4151 SW 314TH ST
4151 SW 314TH ST
—
_
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
4151 SW 314TH ST
FEDERAL WAY WA 98023
NONE
Includes:
Census category: 555 - Non -st
#1
R -3
Type V - N
#2
- - #3 J�
#4 --
Occupancy Group:
I
Construction Type:_
j Occupancy Load:
—
_
I Floor Area (Sq. Ft.):
Basic Plan......... No Census Category .......................... .. 555 -Non- structural roofing p
Mechanical ........ ................ ........... No Occupancy Group ` #1... .............. .. .... .:.....R -3
i'lumbing ........:...... ... .. No
PERMIT EXPIRES November 7, 2004.
Permit issued on May 11, 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 agent: 62�64 4" 41 Date: Li
Feder la Way
COMMUAMDEVELOPMENTSERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063 -9718
253 - 6614115• FAX 2536614129
unumd(IM federalwag.com
The following is
0 PERMIT
APPLICA'T`ION
UF CO ME EL PL DE EN FP
- an in4a wlete application will not be accepted. Please
SITE ADDRESS t/ J--Z -$�IN /Y 1 -iT, SUITE /UNIT #
ASSESSOR'S TAX /PARCEL #
LOT SIZE (sfl
or
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1 )
(Attach separate page/ - le W y/ I wd d—pe -g
PROJECT •- •
TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL
EMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
PROJECT NAME (Name of Business or Owner Last Name) L.'S L1 / 15'
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
PRIMARY PHONE
OFFICE PHONE
MAILING ADDRESS
MAILING ADDRESS
CITY, STATE, ZIP
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
B L
CONTRACTORS REGISTRATION NUMBER (copy of cud required with each application) EXPIRATION DATE
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
FAX NUMBER
( -
NAME PRIMARY PHONE E -MAIL ADDRESS
S'11 ':
PerRCW 19.27.095: Lender informaiiort is
regriired;,if prefect value exceede`$5,000;
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED /APPRAISED VALUE $
SPRINKLERED BUILDING? ❑ YES ❑ NO
PROPOSED USE
VALUE OF PROPOSED WO $ =0
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED?
WATER SERVICE PROVIDER ❑ LAKMHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING S . FT.
PROPOS S . FT. TOTAL
BASEMENT
PROJECT
FLOOR
AREAS
AREA DESCRIPTION
EXISTING S . FT.
PROPOS S . FT. TOTAL
BASEMENT
o NEW o ADDITION
o ALTERATION
FIRST
BUILDING SHELL ONLY? o YES o NO
SECOND
o YES
o NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
o YES
FOURTH
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
o NO
PLATTED LOT? ❑ YES ❑ NO
DECK(COVERED ?)
❑ YES
❑ NO
GARAGE /CARPORT
HOW MANY RS?
TOTAL LXLS 0
TOTAL PROPOSED
TOTAL eusrarG AND PRO ED
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of f xture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
AIR HANDLING
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS (or — combo)
GAS PIPE OUTLETS
WASHING MACHINES
LAVS tsacnroom si ksl
EVAPORATIVE COOLERS
FANS
SHOWERS
SINKS
SUMPS
URINALS
✓ACUUM BREAKERS
820GS REFRIG. SYSTEMS
HOODS (comme.Wl WOODSTOVES
RANGES MISC (Describe)
GAS WATER HEATERS
WATER C rrou�y MISC (Describe)
DRINKING FOUNTAWS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the +forr%ation 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 he 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.
NAME /TITLE
RELATIONSHIP TO
Owner ❑ Agent ❑ Contractor
ITltte)
❑ Architect
DATE
❑ Other
FOR OFFICE USE ONLY
o NEW o ADDITION
o ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100—March 30, 2004 Page 2 of 4 k \Handouts — Revised\Permit Application