97-10300197
CITY OF FEDERAL WAY PERMIT NO: BLD97-0484
33 530 F i r -s t Way South :�!""P�,a .� ..; :s,x :,.1�.': M;' ; "�' :'. ! �'r„.. !;'..,, ,,,. I S S lJ E D : 08/11/97
Feder -al Way, WA 98003 Building Inspection Requests 661-4140 BY: FC2
661-4000 EXPIRES: 02/07/98
ADDRESS:4620 SW 315TFl WAY
NO.: 873219-0030
PROJECT DESCRIPTION 'REROOFING ONLY - NEW PLYWOOD AND 3 -TAB SHINGLES.
= OWNER =_______ -___=====w_____ ____________::___- r-====___-= CONTRACTOR
GEORGE JACKSON JENSEN ROOFING COMPAN
4620 SW 325TH WAY 23641 7TH AVE S #18
FEDERAL WAY WA 98023 DES MOINEES WA 98198
838-1657
824-6210
JENSERC053L8
*** CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY
f
I
�i
i
TAX RATE = 8.2% ***
BLD?:X MEC?: PLM?:
FLR--EXIST--PROP---
DWELLING UNITS: 0
r COMP PLAN.........:?
FEES:
TYPE OF WORK:REP USE:RES
1ST.:
0;
O:sf
STORIES......,.: 0
REQUIRED PARKING..:
0
SPRINKLERS?,.....:? i BUILDING PERMIT....* $ 72.00
CENSUS CATEGORY ..... :555
2ND.:
0:
O:sf
HETGHT... ,.: 0.00 ft
0-3 HP.......
0
HAZARD CLASS...:? SBCC .SURCHARGE.....* $ 4.50
OCCUPANCY GROUP----------
3RD.:
0:
O:sf
VALUATION----------
REQUIRED SETBACKS-------
0
FIRE FLOW....: 0 Spm
:? :? :? :?
OTHR:
0:
O:sf
EXIST..$:' 0
FRONT........,.
0,00 ft
WOOD STOVES...:
TYPE OF CONSTRUCTION-----
BSMT:
0:
O:sf
PROP ... $: 4390
SIDE..........:
0.00 ft
WATER SERVICE..:?
:? :? :? :?
DECK:
0:
O:Sf
0
REAR...........
0,00:ft
SEWER SERVICE..:?
OCCUPANT LOAD------------
GAR.:
0:
O:sf
RECEIVED.:08/11/97
5+ HP........
0
?
0: 0: 0: 0:
TOTL:
0:
O:sf
0
IMPERV SURFACE:
0 sf
SENSITIVE AREAS?.:?
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCI
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WA'
OWNER OR AGENT
FILE COPY
DATE _ �12✓�Z
1
TOTAL FEES $ 76.50
{
' REQUIREMENTS WILL BE MET.
FUEL TYPES.:?
?
FANS..........:
0
BOILERS/COMPRESSORS
WATER CLOSETS......:
0
URINALS........:
0
GAS PIPING.:
0 ft
HOOD..........:
0
0-3 HP.......
0
BATH TUBS..........;
0
DRINKING FOUNT.:
0
FURN<100K...
0
DUCT WORK......
0
3-15 HP......
0
SHOWERS .............
0
SUMPS...........
0
GAS HWT.... :
0
WOOD STOVES...:
0
15-30 HP....;
0
LAVATORIES.........:
0
VAC BREAKERS...;
0
CONV BURNER:
0
FURN>100K......
0
30-50 HP.....
0
` SINKS ...............
0
DRAINS.........,
0
BBQ.........
0
MISC...........
0
5+ HP........
0
DISH WASHERS........
0
LAWN SPRINKLERS:
0
GAS DRYER..:
0
AIR HANDLING UNITS
FUEL TANKS---------
ELEC WTR HEATERS...;
0
OTHER FIXTURES,:
0
RANGE......:
0
<:10,000 CFM:
0
ABOVE GROUND:
0
LAUN WSHR OUTLTS...:
0
GAS LOGS...:
0
> 10,000 CFM:
0
UNDERGROUND.:
0
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCI
I CERTIFY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WA'
OWNER OR AGENT
FILE COPY
DATE _ �12✓�Z
1
TOTAL FEES $ 76.50
{
' REQUIREMENTS WILL BE MET.
v G
V-4
�y EJ'iF1L
.a 119g' APPLICATION FOR BUILDING PERMIT
LEASE PR/NT APPLICATION #
�..
dress
I
Tenant (if known) Lot # TsFi
Building Owner's Name C' Address
' ' r c�' `l E. tr�
Cit > > State I Zip Phone
Nature of Work - C'/lL� " l / A -I ,l v
Name (F,M,L) /
ell, )� ehl ,Lf
Address
City
Contact Person Day Phone
t
Company Nam
Address
City
Contact Person
Contractor's # (card must be presented)
1(,-Yt 11 .1"C''' ( ii .'C- -? L
EU1LDWG-DIVISION
33530 First Way SO
utl
Federal Way, WA 9800'
(206) 661-400
Fax (206) 661-4129c
Other Phone I Fax
Phone Fax
Expiration Date Verified ❑ Yes ❑ No
Name
Address
Cit
State Zi
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Com"l te Rev _r_se Side
#--
Proposed Use
Existing Use
Permit includes:
❑ Mechanical
❑ Building
Type of Work:
❑ Residential
❑ Commercial
❑ New
❑ Addition
Enter 1st Floor
Area Basement
sq ft
sq ft
2nd Floor
Decks
Water Availabilitv ❑ Sewer Availabilitv ❑ On -Site
Contractor Name
Contact
License #
Address
State Zip
Phone Fax
Expiration Date Verified ❑ Yes ❑
Contractor Name
t
Proposed Use
City
❑ Plumbing
❑ Mechanical
❑ Other
❑ Remodel
❑ Garage
❑ Number of Units _
❑ Shed
❑ Deck
❑ Other
sq ft 3rd Floor sq ft
sq ft Gara a sq ft
Existing Floor Area
Proposed Total Area
sq ft
sq ft
tic S stem Availability ❑
Project Valuation
$ `
Furn > 100 BTUs
Existina Blda Valuation
Is
Contractor Name
Contact
License #
Address
State Zip
Phone Fax
Expiration Date Verified ❑ Yes ❑
Contractor Name
t
Address
City
State
Zi
Contact
Phone
Fax
License #
Expiration Date
Verified ❑ Yes ❑ No
Water Closets
Sinks
Urinals Lawn Sprinklers
Bathtubs
Dish Washers
Drinkin Fountains Other
Showers
Electric Water Heaters
Sumps
Lavatories
WashingMachine
Drainsbtal.Frzti#re; C. unt..:::.:::..::............
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
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 employees, upon the accuracy of the information supplied to the city as a part of this application.
� r
Owryrer/Agent:- Date: tJ —
r
&xInING.ArP
Ruv 12/11/96
MECHANICAL EVALUATION ONLY $
Fuel Type (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
Above Ground
Conv Burner
Duct Work
0-3 Tons
Underground
RRn'�
Wood Stoves
3-15 Tons
'%3C81>lijtiattt.
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
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 employees, upon the accuracy of the information supplied to the city as a part of this application.
� r
Owryrer/Agent:- Date: tJ —
r
&xInING.ArP
Ruv 12/11/96
CTT� (V V1 VEV�Al- t-I;Y'l P C'R M 11 N(,; )Li-' U,I ij,�
:335-10 FixsL Wa%) j 1, D lU T L V 1 H C`1 c rA m i 'r
Fe�de ra , 1- W,�,�,, 4,Jt'
41,100
f40 873'r"19 -0(-00
PROJEC1, ONLY
i. OWNER
Glow JACKSON
4620 sw 325j" WAY
F DERAt WAY WA 98023
1657
stet CONI
BE D?: X Nf C , ? PLO?:
IYPE Of WORK:REP tfst:Rcts
CENSUS CATEGORY ..:555
K(UPAKY GROUP - - - - - - - - -
typf or tONSIMMON-1—
O(CUPART 10AV-1-1
0: 0: 0: 0.
('OIL TYPES.:? ?
"13 PIPING.: 0 ft
W11<100r.i.: 0
GAS MVI....: e
(OHV BU IP:
80......<
GAS DRY
;LARGE......
GAS LOGS....
NEW PLYWOOD AND MAD SKINGIts.
CONTRACTOR
JENSEN ROOFING (ONPARY INC
1IL3641 710 AVE S 118
DES "01141ts #A 98198
10
024-6"10
JUSERC0531.8
E+Rt,OITO TIL'
,
FtP `EXIST PROP
IS'i
. O:sf
c
A
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A
191 (fly 04 T Y. TAX talk HA tx
FEES.
SINK! oultDING pmli—it 72.00
9 f" 7,4 0 p Orr q (mapf.r t 4.50
'[WIP SIRM
,f SENSITIVE AREAS?.:?
10
001 ON l URIMS ........ < 0 101AL f CE!, ?f,. 50
If s Hp— ±tI 0 DRINXIM FOUNT,
ii I tip
stmps. . . . ......
VK 11RIAKEFS—.- Q
VAIMS .........
..............
0 Sf op— 0 DISH #ASIIEFS ....... 0 LA49 SPRJH4tR1: 0
HA G UNITS FOIL TAHVS- ItEr NIP 1KATERS ... P OTHER MIMES,: 0
00 CFM: 0 ABOVE c'ROOMP: 0 tAUH VSHP OVILIS...: 0
10,000 UNDIRGROUPD.: 0
11w - - - - - - - - ....
pf"I If Iko �IARILD. RIESIKITIA1, AND CRAOING PMIIS EXPIRE 6K YEAR AFTER IMIt M BSUAW1. "ITS 111101 It s p I!,
I (tsilly IM INC 11014 I'MISPLI sy M, IS 109f ago CORRECT 10 141 KSI OF NY INOKLIKI ANO INC APPLICARF (fly Of FIMAt 4V RLQUISERINTS HILL K WT.
OWNER Of AGE
FIELD COPY
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CDO193 (Rev 4/97)