90-1014319 0-/b / y.3f
FCITYJDF
E ERAL WAY BUILDING PERMIT BUILDIN�G1 IN 55ECTION
(4341 INSPECTION REQUEST LINE -946-6794
PERMIT NO. 90-1651
RA OWNER'S NAME RONALD & CAROL ANDERSEN JOB ADDRESS 30807 21 ST SW
CONTRACTOR OWNER
ADDRESS SAME
CONT. PHONE 838-0416/931-7
CONT. REG. NO. NA
OWNER'S PHONE SAME OWNER'S ADDRESS SAME
TYPE JOB: NEW RESIDENCE
ADDITION XX NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD.
INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADING OTHER RESIDENTIAL
ALTERATION
TAX ACCOUNT NO. 416760-0060
LEGAL DESCRIPTION LOT 6 OF LAKOTA
PALISADES #1.
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE Z U - 3 / _ 9 y
DATE OF APPLICATION 10,112,190
BUILDING INFORMATION
ONE NA
OCCUPANCY 14-1 TYPE OF CONSTRUCTION 5-N
BLDG. SO. FT.GARAGE-285 SF
SET BACKS: FRONT 201
SIDE 5 l EACH REAR 5'
STORIES NA HEIGHT LIMIT 30' MAX
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT.
AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT.
BOILER
RECEIVED
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR
TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE
AIR HANDLING UNIT
NUMBER
LAVATORIES
DRINKING FOUNTAINS
GAS HOT WATER HTR.
MISC.
RETURNED
SINKS
MISC.
CONVERSION BURNER
BASIC FEE
DISHWASHERS
TOTAL FIXTURES NONE
UNIT HEATER
TOTAL MECHANICAL NONE
AMOUNT NONE
VALUATION $4,31R_84
PLANNING DEPT APPROVAL: NO CHANGE IN
BUILDING DEPT APPROVAL: KEVIN ELLI S
USE/OCCUPANCY
ON 10/29/90
PERMIT FEE $72-00
PLAN CHECK FEE
47-00
PLUMBING FEE
TIRE DEPT APPROVAL: NA
CHANICAL FEE
TAL BLDG. FEES
$ 119.00
PUBLIC WORKS DEPT APPROVAL: NA
PART P/C FEE
$EPA REVIEW
WATER SERVICE
WATER MAIN CHG.
$4.50
�
S.B.C.C. FEE
OTHER FEES
Q
DATE PAID /v_ J1 / - LC,U AMOUNT.' 123.50 RECEIPT
AMOUNT DUE $
123. 50
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS
EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORATI
FURNISHE MEI TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPL ABLE CITY F FEDERAL WAY
REQUIREMENTS WILL BE M
I�
OWNER OR AGENT
DATE
v
24
RECEIVED
IL ormit #�26 pe,+
f
OCT 12 1990 CITY OFIE;ERAL WAY t
CITy9FFEDERAL WAY BUILDING PEM! T APPLICATION
BUILDING DEPT ,base Print —
BOX 1 TENANT NAME: ®9J L C.A�L2DEC-TINDS 6Z SC -IBJ r sw-
OWNER E ITE LOCATION Orr 2 tar 31,,_1 . L01"
OWNER'S ADDRESS OBO,7 ZI �bTS. W Q—CITY • 1.#► -J . �PH.ON
DESCRIBE JOB �' _
THE PROPERTY IS OWNED BY: SINGLE/MARRIED MNW EMO PARTNERSHIP CORPORATION
BOX 2 C CTOR'S NA _WOW ASW A► JrJMZSE-�J(_I WL)r- )CONTRACTOR'S REG. #
Card MUST be presented
tIRATI
6R�AD Ss 3a�i�7? Zest' S.L,J. CITY �•� - PHON 838. OW I(
tj IA
—OR— C AUBu,� �
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 0 REGISTRATI N.
BOX 3 CONTACT PERSON W.,OWAvLo PHONE -0
BOX 4 SEWER DISTRICT 1 'E--fJ • LAJ A -Y WATER DISTRICT FED . U -j A -Y
BOX 5 ESTIMATED PROJECT COST -le I , 70 O EXISTING BUILDING VALUATION I ?Jrj 10 00
BOX 6 PROPERTY TAX ACCOUNT�?
LEGAL DESCRIPTION
(If necessary, mit a separate page with the legal description.)
K.C. Plat Recor ' a
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR------/— 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE V n O O
BOX 8 (LI/SINGLE FAMILY ( ) NEW CONSTRUCTION < t
( ) MULTIFAMILY (NO. OF UNITS = ) (&-)'EXISTING STRUCTURE S2 L4 7
( ) COMM ERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY 12.054 SQ FT
BOX 9 PLUMBING
HOT WATER HEATER
WASHER OUTLET
N NG FOUNTAINS
A SPRINKLER VACUUM BREAKERS
TOTAL
MECHANICAL APPLIANCES —
IC FEE $
GAS PIPING, FEET 1
$
'ELEC. AS
NO. FXHOOD
$
GWATER HEAT
$
CIO�+BURN
$
BIZE BTU
$
ALIN NITS
$
H , SI E
$
URS
$
AING UNIT SIZE
$
CIAL HOOD
$
$
$
TOTAL MECHANICAL FEE
$
I CERTIrNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE
AND FU HER 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 EMP EES, UPON THPACCION SUPPLIED TO E TY AS A PART OF THIS APPLICATION.
OWNER/AGENT.- Chau _T DATE:
iza lqqo
ANP4= 3/80
J
y
OFFICE USE ONLY (PLEASE C.
ZONE SETBACKS: FRONT SIDE
PLANNING DEPARTMENT APPROVAL
REMARKS: fL
F BELOW THIS LINE)
'REAR HEIGHT LIMIT
c
e [ &A CC Lk 10CLk C
k -
SEPA: EXEMPT,, NOT EXEMPT—_�L—
FIRE DEPARTMENT APPROVAL DATE
PUBLIC WORKS DEPARTMENT APPROVAL m I (A1 DATE
REMARKS:
TYPE OF JOB: NEW RESIDENCE. RES. ADD/ALT_ C NEW INDUSTRIAL' WD. Ad)/ALT—
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS , )
MULTIFAMILY ADD/ALT' TENANT IMP. OTHER
OCCUPANCY /U TYPE OF CONSTRUCTION ILA—V - -` STORES
&0 BUILDING SQ. FT. moo' @ /7-30 = L/I 30 • -5
BUILDING SO. FT. @ _
BUILDING SO. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ V100
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION 3 3 o
BUILDING DEPARTMENT REMARKS:
RECEIVED
PERMIT FEE
'7 2- • ao
PLAN CHECK FEE
• ��
PLUMBING FEE
D
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
a
S.B.C.C. FEE
OTHER FEES
AMOUNT DUE
z ��
ASSIGNED ADDRESS:
PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt #
BUILDING DEPARTMENT APPROVAL C�
BY DATE 10 _ � ` ��
ACCEPTED FOR FILING
FCITY OF EDERAL WAY BUILDING PERMIT BUILDI94 IN 55ECTION
PERMIT NO.
OWNER'S NAME JOB ADDRESS
CONTRACTOR
ADDRESS
CONT PHONE
CONT. REG. NO.
OWNER'S PHONE OWNER'S ADDRESS
TYPE JOB: NEW RESIDENCE
ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD.
NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS
) MULTI. ADD. SIGN GRADING OTHER
TAX ACCOUNT NO.
LEGAL DESCRIPTION
ISSUED BY
DATE OF ISSUE_ DATE OF APPLICATION
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION
BLDG.SQ.FT. _
SET BACKS: FRONT
SIDE REAR — STORIES
HEIGHT LIMIT
PLUMBING NO.
NO.
MECHANICAL APPLIANCES AMT. AMT.
BOND
WATER CLOSETS
ELEC. HOT WATER HEATER
GAS PIPING FT. BOILER
RECEIVED _
BATHTUBS
LAUNDRY DRAINS
COMPRESSOR TANK(S)
SHOWERS
URINALS
FORCED AIR FURNACE AIR HANDLING UNIT
NUMBER _
LAVATORIES
DRINKING FOUNTAINS _
GAS HOT WATER HTR. MISC
RETURNED
SINKS
MISC.
CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES
UNIT HEATER _ TOTAL MECHANICAL
AMOUNT
M
'T 4KNING DEPT APPROVAL! No CHANGE xl`a USE/OCr"T3'k>'f`-
VALUATION
a
uI.TaDING DEPT PROVAL: KI'i ELLIS M4 10/
PERMIT FEE
PLAN CHECK FEE
rr v. DEPT APPROVAL: NA
UMBING FEE
ECHANICAL FEE
i 'WORKS S itiEPT APPROVAL
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
S.B.C.C. FEE
PAID
WE AMOUNT 123.50 R��°' ip
�
OTHER FEES
AMOUNT DUE
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY
OF FEDERAL WAY
REQUIREMENTS WILL BE MET:
OWNER OR AGENT
DATE
0
SET BACKS AND FOOTINGS
DATE _-.-_— . . .... ..
OX TO POUR FOUNDATION WALLS
DATE ... ... . . . ...........BY
PLUMBING GROUNDWORK
DATE BY ..........
PLUMBING ROUGH IN
DATE_— __ . __ _BY
WATER LINE OX.
GAS PIPING O.K. . . ... ....
MECHANICAL INSPECTION
DATE
O.K. TO ENCLOSE FRAMING
DATE -7
I/ BY
INSULATION
DATE _..—.........BY - ..
. . ... ...
WALL BOARD AND FIRE WALL
DATE BY
FINAL O.K. TO OCCUPY
DATE BY 07)
DCD
PSD
FD
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