04-101332r
10
City of Federal Way y
Community Development Services Building - Single Family Permit #: 04 -101332 - 00 - SF
33530 1st Way S
Fedeml Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129 Inspection request line: 253.835.3050
Project Name: GLAZE
Project Address: 27728 23RD AVE S Parcel Number: 757561 0170
Project Description: Noise abatement upgrades for Port of Seattle.
Owner
Applicant
Contractor
Lender
Karan Lea Glaze
S K M CONSTRUCTION INC
S K M CONSTRUCTION INC
NONE
27724 23RD AVE S
14415 SE 143RD PL
SKMCOI" 052L3 (12/30/05)
FEDERAL WAY WA
14415 SE 143RD PL
98003-6936
TRENTON WA 98059
NONE
Includes:
Census category: 434 - Reside #1 #2 #3 #4
Occupancy Group: R-3
Construction Type: Type V - N
Occupancy Load:
Floor Area (Sq. Ft.):
Census Category ................................................. 434 - Residential alt/add - no, Mechanical................................................. No
PERMIT EXPIRES October 6, 2004.
Permit issued on April 9, 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 ay. /r jj
Owner or agent: Date: `t {tet 64
POS rS CARD ON THE FRONT OF BZAINGDIVISION
`"" ,
,�carr o� Federal Way
y INSPECTION RECORD
INSPECTION REQUEST PHONE #: 253-835-3050
PERMIT #: 04 -101332 -00 -SF
OWNER'S NAME: Karan Lea Glaze
SITE ADDRESS: 27728 23RD S
() FOOTINGS/SETBACKS ( ) FOUNDATION WALL
DO NOT POUR CONCRETE UNTIL THE ABOVE IS APPROVED
() DRAINAGE: Line ( ) Connection
DO NOT POUR SLAB UNTIL THE -ABOVE IS APPROVED
() UNDERFLOOR FRAMING
() ROUGH PLUMBING: DWV Water piping
O ROUGH MECHANICAL Gas piping
() SHEATHING Roof Floor
() SHEAR WALLS
() ELECTRICAL ROUGH -IN Ditch Cover
() FIRE/DRAFTSTOPS
ALL THE ABOVE MUST BE APPROVED PRIOR TO FRAMING INSPECTION
() FRAMING/FIRESTOPPING
THE ABOVE MUST BE APPROVED PRIOR TO INSULATING OR;SHEETROCKING
() INSULATION: Floors Walls Attic
THE ABOVE MUST BE APPROVED PRIOR TO APPLYING SHEETROCK
() WALLBOARD NAILING () SUSPENDED CEILING
THE ABOVE MUST BE APPROVED PRIOR TO TAPING OR INSTALLING CEILING TILE
O ELECTRICAL FINAL
() PLANNING FINAL
O PUBLIC WORKS FINAL
() FIRE FINAL
THE ABOVE MUST BEAPPROVEDPRIOR TO BUILDING I
() BUILDING FINAL ���b C to I A �Z
DO NOT OCCUPY THIS BUILDING UNTIL BUILDING FINAL IS APPROVED
Fede Way RECEIV E
RM IT
C 1AWMIYDEVELOPJ&W SERVICES
33530FLtSTWAY SWA '• PO BOX 9718 A P R o O P LI CAT I O N
FEDERAL WAY, WA 98063-9718
253-661-4115• FAX 253661-4129
www.&uoffederahmu.com CITY OF FEDERAL WAY
R) u) n(NG DEPT.
-1 ® f 56ok-
CO ME EL PL DE EN FP
II1- cam!` 7� Au C- . S SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 7a-TSLe I - —0—La 0 LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) sifC- cz-4c.('� -eel
(Attach-pmafepWf-1 .9ft &gat d-atp -4
PROJECT INFORMATION
TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL
[IDEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
description of work viclyded on this permit onbfl
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE•- •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME J PRIMARY PHONE
US-�a
MAILING ADDRESS CITY, STATE ZIP
Avr—S . d Tao
COMPANY NAME
APPLICANT NAM.
APPLICANT NAME
OFFICE PHONE
Sel,
( -
I
( -sol
MAILING ADDRESS
PI.
5rr a bo
CITY; STATE, ZIP
PHONE
-WAY
FAX NUMBER
(Describe)
UO(lo)
`oCO(K/) OI.
CITY OF FEDERAL BUSINESS LICENSE NUMBER
A--CL--
EXPIRATION DATE
/ /
FAAX`NUMBER �
`` p�
J.— — — — —
B L
J�� Uo
J.5
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application)
Kton C ( �f v 5 � �-S
EXPIRATION DATE
/ /
COMPANY NAME
APPLICANT NAM.
OFFICE PHONE
CITY, STATE, ZIP
Sel,
( -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
5rr a bo
( l -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent Kother onf�(7,
FAX NUMBER
(Describe)
NAM PRIMA Y PHONE E-MAIL ADDRESS
�
PerRCW 19.27.095,. Lender information is
required ifproject, atue exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED/APPRAISED VALUE $_
SPRINKLERED BUILDING? ❑ YES NO
WATER SERVICE PROVIDER ❑ LAKEHA //VE��N
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $ '-t I . DO
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES )(NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE 0 PRIVATE (SEPTIC)
:w a
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
m
FANS
HOODS (commercial)
WOODSTOVES
FIRST
FIREPLACE INSERTS
RANGES
MISC (Describe)
SECOND
FURNACES
GAS WATER HEATERS
CHANGE OF USE?
THIRD
GAS PIPE OUTLETS
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
'
FOURTH
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
ADDITIONAL FLOORS (DESCRIBE)
❑ NO
DECK(COVERED?)
GARAGE/CARPORT
HOW MANY FLOORS?
TOTAL L.XmMo
TOTAL. PROPOSED
TOTAL ER=MG ARD PROPOSED
•'NEWHOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (commercial)
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
CHANGE OF USE?
DUCTS
GAS PIPE OUTLETS
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU?
BATHTUBS (or rub/Shower combo)
SHOWERS
WATER CLOSETS ( iin jj MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bathroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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 claim (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 information supplied to the city as a part of
this application. n
NAME/TITLE
RELATIONSHIP TO PROJECT ❑ Owner ❑ AgentContractor 11 Architect 11
FOR OFFICE USE ONLY
o NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin # 100 — March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application