01-102338City of Federal Way
Community Development Services
33530 1st Way S
Federal Way, WA 98003-6210
Ph: 253.661.4000 Fax: 253.661.4129
Building - Single Family Permit #:01-102338 - 00 - SF
Inspection request line: 253.835.3050
Project Name: BAKER
Project Address: 31813 21ST AVE SW Parcel Number: 122103 9051
Project Description: REPAIR - Double -block (2) piers at tip -out of manufactured home; check level and tighten shims.
Owner
Applicant
Contractor
Lender
LOUISE BAKER
NONE
NONE
NONE
31813 21ST AVE SW #16
0
FEDERAL WAY WA 98023
Floor Area (Sq. Ft.):
NONE
NONE
Includes:
Census category: 434 - Reside
#1 #2
#3
#4
Occupancy Group:
0
Construction Type:
0
Occupancy Load:
Floor Area (Sq. Ft.):
Basic Plan ................................................. No Census Category ................................................. 434 - Residential alt/add - no
Mechanical ................................................. No Occupancy Group#1...........................................0
Plumbing................................................. No
PERMIT EXPIRES December 9, 2001, IF NO WORK IS STARTED.
Permit issued on June 12, 2001
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 'th the laws, rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agen 0 Date:
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Cff.Of CONSTRU 1 ION PERMIT APPLICATION
EJDI— PPLICAIiON NUMBER: ' I - 1 - S
410 -
PPLICATION NUMBER: - -
APPLICATION NUMBER: - -
**The folloW'18tg �cia6Y+T"tion — Please print (in ink) or type**
BUILDiaR;(a DEPT.
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application.
-3 /4L)
SITE ADDRESS: PXm.I 1.00 {y' Q�jr � ASSESSOR'S TAX/PARCEL #:
LEGAL DESCRIPTION OF SUBJECT PROPERTY (ATTACH SEPARATE DESCRIPTION IF LENGTHY): ---ttt
PROJECT• •
TYPE OF PROJECT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description):
Ax
PROJECT NAME: - hd- w
PROPERTY OWNER: I NAME:
CONTRACTOR:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP): I
3 / X/ 3 ;11 F�29 oc 5 k, -W //L&tLe � W0.u� 7 G t��
NAME:
DAYTIME PHONE:
MAILING ADDRESS (STREET ADDRESS; CITY, STATE, ZIP):
EVENING PHONE:
)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
CONTRACTOR'S REGISTRATION NUMBER:
(copy of card required)
EXPIRATION DATE:
APPLICANT: NAME: I DAYTIME PHONE:
"75u ® A49 me -'4 'S• ) 9;:24
MAILING ADDRESS EET ADDRESS; CITY, STATE, ZIP): `EVENING PHONE:
RELATIONS IP TO PROJECT: FAX NUMBER:
❑ ARCHITECT ❑ TENANT ❑ OTHER( DESCRIBE): ( ; ) -
�,!Q �, E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: El PROPERTY OWNER JAPPLICANT ❑ CONTRACTOR
• . .�ING INFORMATION
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: r PROPOSED VALUATION FOR IMPROVEMENTS: $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED: ❑ YES ❑ NO
WATER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER: 11 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
•
0
**NEW RESIDENTIAL CONSTRUCTION ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ : PROTECT FLOOR AREAS
FLOOR
EXISTING SQ. FT.
PROPOSED SQ. FT.
TOTAL
BASEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
FIRST
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
SECOND
THIRD
FOURTH
OTHER FLOORS (DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
AIR HANDLING UNIT(S)
BBQ(S)
BOILERS)
COMPRESSOR(S)
DUCT(S)
BATHTUB(S)
DISHWASHER(S)
DRINKING FOUNTAIN(S)
GAS PIPE OUTLET(S)
INTERCEPTOR(S)
Indicate number of each type of fixture
MECHANICAL
EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG. SYSTEM(S)
FAN(S) HOOD(S) WOODSTOVE(S) g
FIREPLACE INSERTS) RANGE(S) MISC. ( )
FURNACE(S)
GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
LAVATORY(S) URINAL(S) WATER HEATER(S)
RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
SHOWER(S) WASH MACHINE OUTLET
SINK(S) WATER CLOSET(S) MISC. ( )
SUMP(S)
` ■ DISCLAIMER/SIGNATURE BLOCK
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 suppliedAigflhe cityA�a part of thi5QpAcation.
N
❑ PROPERTY OWNER
FOR OFFICE USE ONLY:
❑ CONTRACTOR
DATE:
❑ NEW ❑ ADDITION ❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
CENSUS CODE:
LOT SIZE:
ZONING DESIGNATION:
BUILDING SHELL ONLY? ❑ YES ❑ NO
COMP PLAN DESIGNATION
BASIC PLAN? ❑ YES ❑ NO
SECTION TOWNSHIP RANGE
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
PLATTED LOT? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
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