91-100831CITY OF
FEDERAL WAY
BUILDING PERMIT
BUILDING INSPECTION
941-1555
91-787 RA
DANIEL & DEBRA DRAGOVICH 34430 27TH AVE SW
PERMIT NO. OWNER'S NAME JOB ADDRESS
CONTRACTOR TLA CONSTRUCTION
INC ADDRESS 1125 SAM STREET RENT
CONT. PHONE 850-0604
CONT. REG. NO. HOUSED106P5
OWNER'S PHONE 874-2591 OWNER'S ADDRESS 34430 27TH AVE SW FEDERAL WAY
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_ ADDN
TO LIVING (BASEMENT)
TAX ACCOUNT NO. 502945-0050
LEGAL DESCRIPTION LOT
5 MADRONA TRAILS DIV 1
UED BY JOANNE J)HNSON
DATE OF ISSUE JT�� `�
DATE OF APPLICATION 6-12-91
BUILDING INFORMATION
ZONE RS 7.2 OCCUPANCY
R3 TYPE OF CONSTRUCTION VN
BLDG. SQ. FT. 274
SET BACKS: FRONT 20
SIDE 5 REAR_ 5
STORIES HEIGHT LIMIT 30 _
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 3X5 O
UNIT HEATER
TOTAL MECHANICAL
AMOUNT
17,577.65
VALUATION
PLANNING DEPT APPROVAL:
LS 6-21-91
189.00
PERMIT FEE
PUBLIC WORKS DEPT APPROVAL:
TC 6-28-91
123.00
PLAN CHECK FEE
aMBING FEE 15.00
FIRE/BUILDING DEPT APPROVAL:
KC 7-3-91
HANICAL FEE -
TOTAL BLDG. FEES
PART P/C FEE _
SEPA REVIEW
A
DATE: /
WATER SERVICE
WATER MAIN CHG.
4.50
AMOUNT: $376.50
S.B.C.C. FEE
OTHER FEES P WORKS 45.00
RECEIPT:
AMOUNT DUE 376-r.0
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 INFORMAT)ON 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 �;.� ; !� i ' t�-.,
; DATE
pECEIVED
jU% 13 i9gi
�6 6 COT pl�AALWAY
BOX 1 TENANT NAME:
Permit # (? / 7J" 7
CITY OFIFEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
N
OWNER
OWNER'S ADDRESS O
DESCRIBE JOB
THE PROPERTY IS OWNED BY: SING
BOX 2 CONTRACTOR'S NAME
,V`
> IQE LOCATION -
CITY PHONE�`�
`� e
44,
RRIED PARTNERSHIP CORPORATION
CONTRACTOR'S REG. #
Card MUST be
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE I c) --'2—g' — " i
O/Q S �u>; [Z - OR - I )
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 OF REGISTRATION.
BOX 3 CONTACT PERSON P 17 PHONE _S_0 0_r,04
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST %-1 Olt 000, = EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBE
"LEGAL DESCRIPTION L n`t-
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/P-wed) 1ST FLOOR le 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 (7Q SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY 77700
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLI CES —
BASIC FEE $
NO. WATERCLOSETS
GAS PIPING, EET
$
BATHTUBS
NO. FURNACE, ELEC. GAS
$
=SHOWERS
GAS HOT WATER H ATER
$
LAVATORIES
COXRN ER
$
SINKS
BOBTU
$
DISHWASHERS
AIRNITS
$
ELECTRIC HOT WATER HEATER
HEIZE
$
LAUNDRY WASHER OUTLET
UN
$
URINALS
AIITS, SIZE
$
DRINKING FOUNTAINS
COOD
$
SUMPS, SPRINKLER VACUUM BREAKERS
0T
$
DRAINS
$
OTHER
$
TOTAL FIXTURES
$
�-= 1 4�_ d �>
TO AL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF,MX.,KNOWLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WH,10 f�W lTAOLIWION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTIGATION AND DEFENSE OF SUCH CLAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUON8 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 kCgURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART O�T' HIS APPLICATION.
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE—e-s- Z SETBACKS: FRONT -0-6' SIDE REAR ` HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL � A -2j-9/
REMARKS:
SEPA: EXEMPT ✓ NOT EXEMPT
FIRE DEPARTMENT APPROVAL 14144 DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVALDATE 6 Z y
REMARKS:
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT 7Y NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY & �? TYPE OF CONSTRUCTION U/I% Z_ STORES
L U BUILDING SQ. FT. @ 7 — 1
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ LC
TOTAL SQ. FT. TOTAL VALUATION 175 77s 6 S_
BUILDING DEPARTMENT REMARKS: T �q
� m
(%� ()
RECEIVED
JUN 13 1991
04= FEDEFI& WA
SUIL,OM DEPT.
RECEIVED
ASSIGNED ADDRESS: S :1�
Amount
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE 7 3 G /
I 1
•
ACCEPTED FOR FILING
PERMIT FEE
PLAN CHECK FEE
?-- 3
PLUMBING FEE
�bO
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
P�
S.B.C.C. FEE
< S O
OTHER FEES
AMOUNT DUE
Receipt #
BUILDING DEPARTMENT APPROVAL
BY DATE 7 3 G /
I 1
•
ACCEPTED FOR FILING
CITY OF
FEDERAL WAY
BUILDINGPER Ni I T BUILDI941!N SSECTION
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
VALUATION
MNING DEPT tPPF,'(n xL
MLIC MRKS DEPT hPPWV L.- S'f_
Vii -?8-`'
PERMIT FEE
PLAN CHECK FEE
UMBING FEE
/
.-RE/BUILDING a` DF." ? PiM NI.: fisc
7-3--91
-CHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
WATER SERVICE
WATER MAIN CHG.
,'°7!*
S.B.C.C. FEE
_ ..
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
E
0
SET BACKS AND FOOTINGS
DATE- ___ - --BY . .... . ... ... ...
OX TO POUR FOUNDATION WALLS
DATE ,, BY
PLUMBING GROUNDWORK
DATE BY
PLUMBING ROUGH IN
DATE
WATER LINE O.K . . ....
GAS PIPING O.K.__
MECHANICAL INSPECTION
DATE 17.-V "_K . .....__BY
O.K. TO ENCLOSE FRAMING
DATE . ..... BY 1x13
INSULATION
DATE BY
/23.
WALL BOARD App FIRE WALL
DATE BY
FINAL O.K. TQ OC�(JPY
DATE BY
DCD
PSD
FD
-7- 2 S --
IS e
CALL