91-101351CITY OF
FEDERAL WAY
BUILDING PERMIT
BUILDING INSPECTION
941-1555
91-1307 CA CAMILLE VANDEVANTER DDS MSDJOB 34617
11TH PL S #200
PERMIT NO.
OWNER'S NAME ADDRESS
IRISH HOMES INC RICHA 5503 17TH AVE NW #546 SEATTLE
546-3218
CONTRACTOR
D469i9
CONT. PHONE
CONT. REG. NO. IRISHH246DP OWNER'S PHONE 839-8935 OWNER'S ADDRESS 34617
11TH PL S #200 FEDERAL
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
215470-0110-02 SEE ATTACHED
TAX ACCOUNT NO.
LEGAL DESCRIPTION
SUED BY JOANNE
JOHNSON DATE OF ISSUE DATE OF APPLICATION 9-18-91
BUILDING INFORMATION
ZONE OP
OCCUPANCY B2 TYPE OF CONSTRUCTION VN
BLDG. SO. FT. 1280
SET BACKS: FRONT
50' SIDE 20 REAR 20 __._ STORIES
HEIGHT LIMIT 301 _
PLUMBING NO.
NO. MECHANICAL APPLIANCES AMT.
AMT.
BOND
WATER CLOSETS 1
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 I
DRINKING FOUNTAINS GAS HOT WATER HTR. MISC
7
RETURNED
SINKS
MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS
TOTAL FIXTURES 9X5 _AS:QO UNIT HEATER TOTAL MECHANICAL _
AMOUNT
VALUATION 17,
382 _ 40
PLANNING DEPT APPROVAL: LS 9-30-91
FIRE DEPT APPROVAL: KC PK 10-1-91
PERMIT FEE
189_nn
AN
AN CHECK FEE
KFFEE
123-0 n
BUILDING DEPT APPROVAL: KC 10-1-91
3_Il0
'WUMBINGMECHANICAL
UST SIGN BATHROOM AFFADAVIT
FEE _
TOTAL BLDG. FEES
I
PART P/C FEE
`
DATE:
SEPA REVIEW
WATER SERVICE
AMOUNT:
WATER MAIN CHG.
$370-95,
S.B.C.C. FEE
4.50
11-L41
OTHER FEES
9,45
AMOUNT DUE
37 L-95
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 INFO I FURNIS ED BY ME IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE ET:
��
OWNER OR AGENT
DATE
WAY
CITY OF
FEDERAL WAY
BUILDING PERMIT BUILDING
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. 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
171382.40
ANNING DEPT APPJOV�
LS 9-30-91
VALUATION
RE DEPT APPROVAL: Kc
PK 10--1•-91
00
PERMIT FEE
.
s.00
PLAN CHECK FEE
'ILDING DEPT APPROVAL:
KC I0-3.--91
PLUMBING FEE
nr
ST SIGN BATHROOM A'4`P'ADAVIT
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
r
SEPA REVIEW
WATER SERVICE
,� e�?_;..'�'. ;��• ���y�
WATER MAIN CHG.
.. ---•moi '
S.B.C.C. FEE
' _
L'.k.11LlT,
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
SET BACKS AND FOOTINGS
DATE —.....BY —..- _—
OX TO POUR FOUNDATION WALLS
DATE ---- BY
PLUMBING GROUNDWORK
DATE __._.._ - BY
PLUMBING ROUGH IN
DATE .-�l � � BY
____....-
WATERLINE O.K. _
GAS PIPING O.K.---..... _....-.... .....
MECHANICAL INSPECTION
DATE
O.K TO/ENCLOSC�E !FRAMING
DATE ! _...`. I._ BY _.._—.
INSULATION a
DATE ...�! .✓ ``,_. BY �_ .-� _
WALL BOARD AND FIRE WALL
DATE r/�^9� BY Z73
FINAL O.K. TO OCCUPY
DATEBY
J�
NO
/
Ir!
DCD
PSD
FD
d/a9
cert
RECEIVED � Pe t # g � -- �:3 U -7 �7-1
SEP 18 1991 CITY OF FEDERAL WAY
Q;I"!vOf f-LUERAL WAY BUILDING PERMIT APPLICATION
SWIL01W DEPT — Please Print
BOX 1 TENANT NAME: Camille VanDevanter D.D.S. , M.S.D.
OWNER Camille VanDevanter D.D.S. M.S.D. SITE LOCATION 34617 - 11th Place S. # 200
OWNER'S ADDRESS 34617 - i1th Place South # 200 CITY Federal 4day PHONE 839-8935
DESCRIBEJOB Tenant Improvement of existing dental offices
THE PROPERTY IS OWNED BY: SINGLE/MARRIED XXXX PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Irish Homes, Inc. - Richard D. King CONTRACTOR'S REG. # Ik-Is-HH 246DP
5503 - 17th Ave. N.W. #546 Seattle 546 -3218Cd MUST be presente
CONTRACTOR'S ADDRESS CITY PHONE
EXPIRATION DATE -7- 2 G -��
1•
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 Mark Preston, AIA / Preston Architecture PHONE 927-1213
BOX 4 SEWER DISTRICT WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST $25, 000 EXISTING BUILDING VALUATION 720,000
BOX 6 PROPERTY TAX ACCOUNT NUMBE
LEGAL DESCRIPTION
- 0110-4 0
(17 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 / 1280
3RD FLOOR / BASEMENT / DECK /
GARAGE /
BOX 8 ( ) SINGLE FAMILY
( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
(X)j EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SQ FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES — BASIC FEE $
NO. -"1- WATERCLOSETS
GAS PIPING, FEET
$
BATHTUBS
N0. FURNACE, ELEC. GAS $
SHOWERS
GAS HOT WATER HEATER
$
-1- LAVATORIES
CONVERSION BURNER
$
-7- SINKS
BOILER, SIZE BTU
$
DISHWASHERS
AIR HANDLING UNITS
$
ELECTRIC HOT WATER HEATER
HEAT PUMPS, SIZE
$
LAUNDRY WASHER OUTLET
UNIT HEATERS
$
URINALS
AIR COOLING UNITS, SIZE
$
DRINKING FOUNTAINS
COMMERCIAL HOOD
$
SUMPS. SPRINKLER VACUUM BREAKERS
OTHER
$
- DRAINSLzmirs - f'lro .e-
$
_TOTAL FIXTURES ��'
$
TPTAL 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 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 EMPLLY-EES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
OWNER/AGENT:
DATE: j " /9 `7/
ANP -008 3/90
ZONE SETBACKS: FRONT_
PLANNING DEPARTMENT APPROVAL
REMARKS:
UFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
_76, SIDES REAR HEIGHT LIMIT
SEPA: EXEMPT °s NOT EXEMPT
FIRE DEPARTMENT A PROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:
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 TYPE OF CONSTRUCTION 61 STORES
<1/�r (cam BUILDING SQ. FT. If Z @
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @
BUILDING SQ. FT. @ ( e = Z Q
TOTAL SQ. FT. TOTAL VALUATION
BUILDING DEPARTMENT REMARKS:
SSP � 8 1g91
BU
RECEIVED
ASSIGNED ADDRESS:
Amount
PARTIAL PLAN CHECK FEE RECEIVED
Date
Receipt #
BUILDING DEPARTMENT APPROVAL
BY DA'
PERMIT FEE
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
OTHER FEES rP Fee 1 S
AMOUNT DUE
ACCEPTED FOR FILING