00-105967 .44.
ederal Way*
Community Development Services Building - Single Family Permit #:00 - 105967 - 00 - SF •
33530 lst Way S
Federal Way,WA 98003-6210 Inspection request line: 253.661.4140
Ph:253.661.4000 Fax:253.661.4129 (3:30pm cut-off for next day inspections)
Project Name: CARLSON pool, code T \
Project Address: 31702 5TH AVE S Parcel Number: 794170 0240
Project Description: REPAIR-Repair fire damage to single family residence in accordance with approved bid submittal
and subject to field inspections and corrections.4fal n icyAti n ,- M. k
Owner Applicant Contractor " Lender
Family Trust Carlson NONE NONE MUTUAL OF OMAHA
283 MISTYWOOD DR
COUPEVILLE WA
98239-3610 NONE
Includes:
Census category: 434-Reside #1 #2 #3 #4
Occupancy Group: R-1
Construction Type: Type V-N
Occupancy Load:
Floor Area(Sq.Ft.):
Census Category 434-Residential alt/add-no Mechanical No
Occupancy Group#1 R-1 Plumbing No
PERMIT EXPIRES June 10,2001,IF NO WORK IS STARTED.
Permit issued on December 12,2000
I hereby certify that the above information is correct and that the construction on the above described property and
the occupanc • _ •- se will be in accordance with the laws,rules and regulations of the State of Washington and
the City of`ederal Way.
Owner or agent: Date: /vim/�/C10
C
.r ' •
POSSHIS CARD ON THE FRONT OF BUILD r
p•F ^- BUI ING DIVISION
uv��ErzFlL INSPECTION RECORD
INSPECTION REQUEST PHONE#: 253-661-4140
Request must be received by 3:30 PM for next day inspection
PERMIT #: 00-105967-00-SF
OWNER'S NAME: Family Trust Carlson
SITE ADDRESS: 31702 5TH S
O FOOTINGS/SETBACKS () FOUNDATION WALL
DO NOT POUR CONCRETE UNTIL. THE ABOVE IS R ' 0
( ) DRAINAGE: Line ( ) Connection
DO NOT POUR SLAB UNTIL'111E ABOVE IS APPROVED
( ) UNDERFLOOR FRAMING
() ROUGH PLUMBING: DWV f/1,5-1 SS Water piping I /24r/le/ S5
( ) ROUGH MECHANICAL ��� /
� / 4/� p g •
/ Gas i in
() SHEATHING Roof J 3 ✓ Floor
( ) SHEAR WALLS
( ) ELECTRICAL ROUGH-IN Ditch Cover
( ) FIRE/DRAFTSTOPS
ALL THE ABOVE MUST BE APPROVED PRIOR TO FRAMING INSPECTION= u !
( ) FRAMING/FIRESTOPPING '- S '^� 4‘'.�
THE ABOVE MUST,'BE APPRO D PRIOR TO INSULATING OR SHEETROCKING
( ) INSULATION: Floors Walls g O 1 Attic
THE ABOVE MUST BE APPROVED PRIOR TO APPLYING SHEETROCI
O WALLBOARD NAILING !zTe,f`-
O SUSPENDED CEILING
THE ABOVE MUST BE APPROVED PRIOR TO TAPING OR INSTALLING CEILING.TILE
O ELECTRICAL FINAL
( ) PLANNING FINAL
() PUBLIC WORKS FINAL
( ) FIRE FINAL
THE ABOVE MUST BE APPROVED PRIOR TO BUILDING DEPARTMENT FINAL
( ) BUILDING FINAL t N )D/! �b I� •- ilt S(.4 i f n Cp /Tj
DO NOT OCCUPY THIS BUILDING UNTIL BUILDING FINAL IS APPROVED
.. CONSTR ION PERMIT APPLICATION
F� i-- APPLICATION NUMBER: 0 0 - ] _1,2J4 J- 51-
N>N> AY DEC 12 ''
APPLICATION NUMBER: _ _ - _ _ _ - _ _
vi i r OF FEDL AL WAY APPLICATION NUMBER: - -
BUILDING DEP''
**The following is required information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: 3/ 74? ) * f-r? .1 ;* ASSESSOR'S TAX/PARCEL #: 7 i V .1 2 Q - €. ye)
LEGAL DESCRIPTION OF SUBJECT PR,OPER,TY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): L/ - 1 I G > -
70ititt -- 0 A-r 0 7 I,044'
f
"Iii / , --/ r' ' IMj _4!y . / IFi r+R *but
■ PROJECT INFORMATION '
TYPE OF PROJECT(This application): BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): /✓Z dn441A41r /-1/0651'1"- 4 /pee, /Ass
p7/-),,/ / r
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
f�Jyy/ti4,404/ W e')d 7 - ET
MAILING ADDRESS ADDRE ,CITY,STATE,ZIP:
,2r w err 41..0t t,id .. 9
•
CONTRACTOR:
NAME: DAYTIME PHONE:
At . 74 "SAO ea444 L ...,w i (."3 ) 9J f -gtv;a
MAILING ADDRESS(STRE A DDRESS;CIITYY,STATE,ZIP): � EVENING PHONE:
` J /�`
. CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - ( )
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
APPLICANT: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
RELATIONSHIP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ?3, 6D0 %
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 5'4
4 tC
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
•
**NEW RESIDENTIAL CONSTRUCTION•Y** • '
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS •
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC El GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
■ 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 daim(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 its officers and employees,upon the accuracy
of the informa "on supplied to the city a a part of this application.
A
.�
NAME/TITLE: t67i�% 461-74z./2-c___/ DATE:DATE: i .
El PROPERTY OWNER El APPLICANT IV-CONTRACTOR
FOR OFFICE USE ONLY:
0 NEW ❑ ADDITION ❑ ALTERATION ❑REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE: LOT SIZE:
ZONING DESIGNATION BUILDING SHELL ONLY? ❑ YES El NO
COMP PLAN DESIGNATION BASIC PLAN? ❑ YES ❑ NO
SECTION' TOWNSHIP RANGE NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? El YES El NO CHANGE OF USE? ❑ YES El NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129