98-104116 ` 1 8- /0 91/ 4v
CITY OF FEDERAL WAYu pp L. PERMIT NO: BLD98-0750
33530 First Way South ELI D.G. N(.3 iPE.I!";;�, �'II . . ,,,,, ISSUED: 10/28/98
Federal Way, WA 98003 Building Inspection Requests 253-661-4140 BY: FC2
253-661-4000 EXPIRES : 04/26/99
ADDRESS:28614 11TH AVE S
NO , : 515296.-0650
PROJECT DESCRIPTION:Reroof; t/o, plywood, reroof, dimesional
?= OWNER T CONTRACTOR =_____.__ .=-_-_-..-_ T LENDER - ._-.---.
SHELLEY HARTMAN ° JENSEN ROOFING COMPANY INC
28614 11TH AVE S 3 17321 MILITARY RD S 1
MI6
DERAL WAY WA 98003 SEATAC WA 98188
73-529-8907 $ 206-241-5774
JENSERC053L8
I
*** CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE = 8.6% ***
BLD?:X MEC?: PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 0 COMP PLAN •' FEES:
TYPE OF WORK:REP USE:RES 1ST.: 0: O:sf STORIES • 0 REQUIRED PARKING..: 0 SPRINKLERS' •' I BUILDING PERMIT....* $ 144.00
CENSUS CATEGORY •555 2ND.: 0: O:sf HEIGHT - 0.00 ft HAZARD CLASS •9 SBCC SURCHARGE * $ 4.50
OCCUPANCY GROUP 3RD.: 0: 0:sf VALUATION REQUIRED SETBACKS FIRE FLOW 0 gpm
:? :? :? :? OTHR: 0: 0:sf EXIST..$: 0 FRONT • 0.00 ft
TYPE OF CONSTRUCTION BSMT: 0: O:sf PROP...$: 13000 SIDE • 0.00 ft WATER SERVICE..:?
:? :? :? :? DECK: 0: O:sf REAR • 0.00:ft SEWER SERVICE..:?
OCCUPANT LOAD GAR.: 0: O:sf RECEIVED.:10/28/98
: 0: 0: 0: 0: TOTL: 0: 0:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:?
WTYPES.:? ? FANS • 0 BOILERS/COMPRESSORS I WATER CLOSETS • 0 URINALS • 0 ; TOTAL FEES $ 148.50
PIPING.: 0 ft HOOD • 0 0-3 TON • 0 BATH TUBS • 0 DRINKING FOUNT.: 0
FURN<100K..: 0 DUCT WORK • 0 3-15 TON • 0 2 SHOWERS • 0 SUMPS • 0
GAS HWT • 0 WOOD STOVES...: 0 15-30 TON...: 0 LAVATORIES • 0 VAC BREAKERS...: 0
CONV BURNER: 0 FURN>100K • 0 30-50 TON...: 0 ' SINKS • 0 DRAINS • 0
BBQ • 0 MISC • 0 50+ TON • 0 DISH WASHERS • 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS t ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0
RANGE • 0 <:10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0
GAS LOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
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 -_.. , I_11i,A_4__ 4n,44,..,. _---?L_"�-:. DATE __4 _22 __..-_Zi
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BUILDING DIVISION
G 33530 Fust Way South
=�'' EDE1ZFIL_ R E C 4 p E D Federal Way,WA 98003
' FiY
1998 (253)661-4000
r,-� 2Fax(253)661-4129
v. Y
=M
:-r.
APPLICATION FOR BUILDING PERMIT
PLEASE PRINT APPLICATION # 1"tk E8 ' 0 c SO
lAddress
Tenant(if known) !he � Lot# Assessor's Tax #
Building Owner's Name �, Address
�" l a 3 6 I�r r Ave_ yr.
City FCCt.t il/if.L Lc/hi, State (i(JJ Zip . Phone ;2)3- ,c)1.- Z5 07Nature of Work (C7Ta
r
Name (F,M,L)
,L fPr15Pi? gL)'?RW1 e_ hYIL
Address
7 )) 111 II' Q a j
City Serday State L n//} Zip (/ I
Contact Person Day Phone Other Phone Fax
Tin() or hi gh - �41- S 77 Lf
FEDERALWAY BUSINESS LICENSEE
Company Name ,,
Address
City State Zip
Contact Person Phone Fax
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
Name
! II �fi
Address
City State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
Please Complete Reverse Side 41
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CD0193(Rev 4/97)
1/0 t'�`l t�ccx , Y'e--�reY �151 m
. `iT C ff r::.:,.....'.' Ei
U' R� T..„f��. i i ii'i„?,,,„,„„„,i„„„„„„„„„„, i'ir.„.„„„....i'i, existing use Proposed Use
Permit includes: 0 Building ❑ Plumbing 0 Mechanical 0 Other
Type of Work: 0 Residential ❑ New 0 Remodel 0 Number of Units 0 Deck
❑ Commercial ❑ Addition ❑ Garage ❑ Shed ❑ Other
Enter 1st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area sq ft
Water Availabiiit 0 Sewer Availability ❑ On-Site Se.tic S stem Availabilit ❑ Pro-ect Valuation $ 1^
Zoning Lot Size Existing Bldg Valuation $
Name
Address
City State Zip
MEOHANICAVCONTRACTORMunam
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified 0 Yes ❑ No
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑. No
f. . .... t1... I Ti IFF ;.E,'fJFUN 1`;.;::: :.,;>:..;:.;:.;:. _
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total'Fixture Count
MECHA C LUNiICOUN1 . . MECHANICAL EVALUATION ONLY $:: : :;;::
Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground _
Cony Burner Duct Work 0-3 Tons Underground
.............. ............................................
BBQ's Wood Stoves 3-15 Tons Tbtaj,Unttcoont ..
DISCLAIMER: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 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 employees,upon the accuracy of the information supplied to the city as a part of this application.
Owner/Agent: dAlivtj,t4L, ,..,61 -4,-1,1 (2...e.--6- Date: IC` -)D -
5O
flEvs[08/26 B/28/97