03-105252 1 1111 0
City ofFederalWay
CommunitynityDevelopment Services Building - Commercial Permit #: 03 - 105252 - 00 - CO
33530 1st Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.835.3050
Project Name: RISSHO KOSEI-KAI OF SEATTLE
Project Address: 28621 PACIFIC HWY S Parcel Number: 332204 9124
Project Description: Reroof-shake to metal roofing
Owner Applicant Contractor Lender
Ed Tilton &Carolyn Tilton DALE BROTHERTON TAKUMI COMPANY RISSHO KOSEI-KAI OF SEATTLE*
371 GRANDVIEW AVE TAKUMI COMPANY TAKUMC*132RU 5/28/04 RISSHO KOSEI-KAI OF SEATTLE
CAMANO ISLAND WA 12054 31ST AVE NE 12054 31ST NE 5511 MARTIN LUTHER KING JR W
98282-8636 SEATTLE WA 98125 SEATTLE WA 98125-5502 SEATTLE WA 98118
Includes:
Census category: 437-Comm #1 #2 #3 #4
Occupancy Group:
I 4
— — I
Construction Type: 1
Occupancy Load: -1 - _ -
Floor Area(Sq.Ft.): 1 —
Census Category 437-Commercial alt/add Mechanical No
Number of Stories I Permit for Building Shell Only Yes
Plumbing No
PERMIT EXPIRES May 24,2004.
Permit issued on November 26,2003
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 Way.
Owner or agent -- Date: "G/�
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• CONSTRUCT l 10 PERMIT APPLICATION
CITY OF �� APPLICATION NUMBER: ' 4 _0_ -D S
Federal Way APPLICATION NUMBER: - -
APPLICATION NUMBER: - -
"The following is required information-Please print(in ink)or type"
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
- 1. I'1'`PROPERTY INFORMATION
SITE ADDRESS: JA.22! /94:467-C Fvf ASSESSOR'S TAX/PARCEL #: -3_ 2 Z ci-L-- ' L 2' --
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DES RIPTION IF LENGT Y): „ 1 t a, A'- 5; , 1
G Ft�ltitrusa1 �%t,..c�s7�-/ic�c. t�� �I,�o•, ia ,..,„4-,,,,,_ • 1 ►if, , r�� , -
1/11/MI '
- :y • ;.:" 1'1 PROJECT INFORMATION -
TYPE OF PROJECT(This application): ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION
❑ ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): �'e___V52
PROJECT NAME: c----.\551,‘0ICosej, kat
DI PEOPLE INFORMATION - . .
PROPERTY OWNER: NAMAAE1
; DAYTIME PHONE
S5110/ k `
a S (#6-- i (2 ) 72—-4-t2-&5"MAILING ADDRESS(STREET DDRESS;CITY,STATE,ZIP):
_.e,--5-1/ AAL, 11, r 75,, 5 Cir1/l 9'Scics�
CONTRACTOR: I NAME: DAYTIME PHONE:
C-U L( Ce AW /N ' (ebb) 6 22- X74
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): i EVENING PHONE:
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- - ( G) C22. 2-Crd
CONTRACTOR'S REGISTRATION NUMBER:
(� /^� / � I EXPIRATION DATE:
r
(copy of card required) L A-- -CL -L G 4 I 2— e.C c /---/ 6
APPLICANT: NAME: DAYTIME PHONE:
p �a-.L- C 1 c w4 n (a),(4rq-N y ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
5 �, a Le �� ! ( )
RELATIONSHIP TO PROJECT: j FAX NUMBER:
❑ ARCHITECT o TENANT /Cf�ER( DESCRIBE): i ( ) -
E-MAIL ADDRESS:
I
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT ❑ CONTRACTOR
1
--17 DETAILED BUILDING INFORMATION -
EXISTING USE: EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ I 2-/,
SPRINKLERED BUILDING? ❑ YES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:0 YES ❑ NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
flb
**NEW RESIDENTIAL CONSTRUCTION ONO*
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
.. ■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH4111111111
OTHER FLOORS(DESCRIBE) -j'
DECK
GARAGE -
HOW MANY FLOORS?
TOTAL:
- ■ FIXTURES -.
Indicate number of each type of fixture
MECHANICAL Value of Mechanical Work: $
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: 0 ELECTRIC 0 GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC o GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) 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,induding its officers and employees,upon the accuracy
of the information supplied to the city as a part of this application.
NAME/TITLE:7jr---- CC-01-4.- V- .
Cz (/ DATE: ___LV�� -(C 3
❑ PROPERTY OWNER ❑ APPLICANT g.C—RACTOR
FOR OFFICE USE
_ ONLY: 1
:IINEW.; ._OADDTION
,; _D ALTERATION :.1.`o REPAIR TE-NANTIMPROVE:MEN - -
CENSUS'cODE:- -' arOX- A� X:*. ' LOT SIZE:`-, "' :. - : -,�. `r if _
:ZONING DESIGNATION y o
- ���-��-: ��,,.�`��``"��.� BUILDING SHELG'ON�Y?:�.0 YES ''•.-❑ NO :'41
-COMP PLAN DESIGNATION -
4,' x -'BASIC PLAN? ,-,£❑YES •El'NO "
SECTION. . ....:TOWNSHIP 'RANGE ; NEW ADDRESS REQUIRED? ❑YES ❑ NO
PLAITED LOT? -'.`❑YES ❑ NO ., y.-z‘`'CHANGE OF USE? ❑YES'-`-t]NO
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.atvoffederalway.Com