91-100834CITY OF
FEDERAL WAY
BUILDING PERMIT
q I -1 W3 531r
BUILDING INSPECTION
941-1555
91-786 CA PRO
IMAGE
1938 S
SEATAC MALL
PERMIT NO. OWNER'S NAME
JOB ADDRESS
TEN COM
11016 159TH AVE NE
REDMOND
CONTRACTOR ADDRESS
CONT. PHONE 881-3134
CONT. REG. NO. TENCOC137KK OWNER'S PHONE 839-6156 OWNER'S ADDRESS 1928 S SEATAC
MALL
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL
ADD. XX INDUSTRIAL ADD.
NEW PUBLIC PUBLIC ADD.
NEW MULTI -FAMILY (UNITS ) MULTI. ADD. SIGN
GRADING OTHER
TAX ACCOUNT NO. 762240-0010-03
LEGAL DESCRIPTION (SEE ATTACHED)
ISSUED BY JOANNE JOHNSON
_ DATE OF ISSUE 'ItDATE
OF APPLICATION 6-13-91
BUILDING INFORMATION
",ONE CC OCCUPANCY B2
TYPE OF CONSTRUCTION
VN
BLDG. SO. FT. 650
ET 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 $4,745 _ nn
PLANNING
DEPT APPROVAL:
BK
6-19-91
72.00
PERMIT FEE
FIRE/BUILDING DEPT APPROVAL
KC
6-24-91
PLAN CHECK FEE 4 7
PLUMBING FEE
MECHANICAL FEE
OTAL BLDG. FEES
/
ART P/C FEE
DATE:
,EPA REVIEW
WATER SERVICE
WATER MAIN CHG.
AMOUNT:
$197-10
S.B.C.C. FEE 4-50
'7
OTHER FEES -3-60
RECEIPT:
AMOUNT DUE 127-10
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 INFORMATIO RNISHED BY ME TRUE AND RRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE MET
r i
j
OWNER OR AGENT
-
DATE /
PITY OF
EDERAL WAY
BUILDING PERMIT
BUILDING INSPECTION
941-1555
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
da LIED BY
DATE OF ISSUE DATE OF APPLICATION
Nw
BUILDING INFORMATION
ZONE
OCCUPANCY TYPE OF CONSTRUCTION
BLDG. SO. 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
t/�+�ariilatEs �*�
PERMIT FEE
N CHECK FEE
MBING FEE
M=CHANICAL FEE
TOTAL BLDG. FEES
1
PART P/C FEE
SEPA REVIEW
—" -
WATER SERVICE
K �u
WATER MAIN CHG.
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
l�\ ��
SET BACKS AND FOOTINGS
DATE ___ - _ BY
OX TO POUR FOUNDATION WALLS
DATE _._ __-.... ..BY __
_.-_
PLUMBING GROUNDWORK
DATE _
PLUMBING ROUGH IN
DATE,_.... - -_,_..___BY ..._
WATER LINE O.K.
GAS PIPING O.K.
- ... _-.. ...... ..-
MECHANICAL INSPECTION
DATE--..._-
O.K. TO ENCLOSE FRAMING
DATE __- _ BY . ..... -_
INSULATION
DATE
- BY ----.-
-__
WALL BOARD AND FIRE WALL
DATE - - --_BY
FINAL O.K. TO OCCUPY
//
DATE L......0 /_5 ._5' —BY _-
DCD
PSD
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RECEIVED 0
JUN 13 1991
=02PL1
AV w
0 Spermit # � 1 � L_(A
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
BOX 1 TENANT NAME: rLo __� 0-�
OWNER rr I 1
DESCRIBE JOB m S Z CU's
THE PROPERTY IS OWNED BY: SINGLE/MARRIE
SITE LOCATION / y S So
yCITYS�'i9-c PHONE
PARTNERSHIP
CORPORATION
BOX 2
CONTRACTOR'S NAME
CONTRACT R'S
REG. #Z;;te41eX /_7 <_
N0. FURNACE, ELEC. GAS
CONTRACTOR'S ADDRESS //O/� / S—�'
� N2 CITY
Card MUST be presented
PHONE �
CONVERSION BURNER
EXPIRATION DATE c if
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
—OR—
$
UNIT HEATERS
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECIALTY
CONTRACTORS AND
$
CHAPTER 18.27.110 WHIC OHI BITS ISSUING PERMI
S W HOUT PROOF OF REGISTRATION.
OTHER
BOX 3
CONTACT PERSON
PHONE rr—k/ 3/7
BOX 4 SEWER DISTRICT
WATER DISTRICT
BOX 5
ESTIMATED PROJECT COST P—
EXISTING BUILDING VALUATION
BOX 6
PROPERTY TAX ACCOUNT UMBER Z 2
D
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7
BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOOR / �.� 2ND
FLOOR /
3RD FLOOR / BASEMENT / DECK /
GARAGE /
BOX 8
( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
{---)--EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY /���
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. WATERCLOSETS
BATHTUBS
SHOWERS
LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
URINALS
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
DRAINS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
BASIC FEE $
GAS PIPING, FEET
$
N0. FURNACE, ELEC. GAS
$
GAS HOT WATER HEATER
$
CONVERSION BURNER
$
BOILER, SIZE BTU
$
AIR HANDLING UNITS
$
HEAT PUMPS, SIZE
$
UNIT HEATERS
$
AIR COOLING UNITS, SIZE
$
COMMERCIAL HOOD
$
OTHER
$
TOTAL MECHANICAL FEE
$
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 SAV ARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, EXPENSES, AND ATTORNEYS'
FEES INCURRED IN INVESTI I AND DEFENSE OF SUCH CLAIM) WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
AND FILED AGAINST THE Y FEDERAL WAY, BUTALY WHE UCH CLAIM ARISES OUT OF THE RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOY ON THE ACCURACYAF THE I MATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: Y
ANP -008 3/90
ZONE GC— SETBACKS: FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS: A'
0
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
SIDE_tJ W REAR NI 4- HEIGHT LIMIT NtA-
" L q - el(_ vk-
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE .
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVA
REMARKS:
DA
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS )
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY 9-,,- TYPE OF CONSTRUCTION 1/N STORES
BUILDING SQ. FT. S- U @ 3 6
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ /tA,O
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
ASSIGNED ADDRESS:
Amount
RECEIVED
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
PERMIT FEE -7-2-
PLAN
Z
PLAN CHECK FEE !:I�
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE — 4s-0
OTHER FEES FD Fie- 3'(0
L
AMOUNT DUE
BUILDING DEPARTMENT APPROVAL
DATE
ACCEPTED FOR FILING