90-100674 a-/OO
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 941-1555
PERMIT NO. 90-963CA OWNER'S NAME TWIN LAKES CHIROPRACTIC CTR JOB ADDRESS 2500 "E" SW 336 ST
CONTRACTOR SHINSTINE ASSOC ADDRESS POB 1027 PUYALLUP CONT. PHONE 840-1770
CONT. REG. NO. SHINSI*1O7CZ 12/90 OK OWNER'S PHONE 848-8688 OWNER'S ADDRESS 133 23 ST SE PUYALLUP
TYPE JOB: NEW RESIDENCE ADDITION NEW INDUSTRIAL NEW COMMERCIAL COMMERCIAL ADD. INDUSTRIAL ADD. NEW PUBLIC PUBLIC ADD.
NEW MULTI-FAMILY (UNITS ) MULTI.ADD. SIGNGRADING OTHER COMMERCIAL ALTERATION (T.I. )
TAX ACCOUNT NO. 132103-9096 LEGAL DESCRIPTION LOT 2 UNDER KING RECORD #7904230952 AND
REVISED UNDER KING CO #8104290296 AND 8501140624.
ISSUED BY ELIZABETH SNYDER DATE OF ISSUE DATE OF APPLICATION 6/21/90
BUILDING INFORMATION
eNE NA OCCUPANCY B-2 TYPE OF CONSTRUCTION _ 5-N BLDG. SQ. FT OFFICE=1612
SET BACKS: FRONT NA SIDE NA REAR _ NA STORIES NA HEIGHT LIMIT NA
PLUMBING NO. NO. MECHANICAL APPLIANCES AMT. AMT. BOND
WATER CLOSETS ELEC. HOT WATER HEATER GAS PIPING FT. BOILER
RECEIVED _
BATHTUBS LAUNDRY DRAINS A__ COMPRESSOR _-_ _ TANK(S)
SHOWERS URINALS FORCED AIR FURNACE AIR HANDLING UNIT NUMBER
LAVATORIES DRINKING FOUNTAINS GAS HOT WATER HTR. MISC
RETURNED
SINKS 1 MISC. CONVERSION BURNER BASIC FEE
DISHWASHERS TOTAL FIXTURES 2X$5.00 UNIT HEATER TOTAL MECHANICAL NONE AMOUNT NONE
VALUATION $16,311_00
PERMIT FEE $180-00 PLANNING DEPT APPROVAL = NOT APPLICABLE (NO CHANGE IN OCCUPANCY OR USE)
PLAN CHECK FEE 117.00 SEPA = " "
PLUMBING FEE 10-00
eCHANICAL FEE FIRE DEPT APPROVAL = KEVIN ELLIS ON 6/28/90
TAL BLDG. FEES __$307.00 PUBLIC WORKS APPROVAL = NOT APPLICABLE
PART P/C FEE
SEPA REVIEW
WATER SERVICE BUILDING DEPT APPROVAL = KEVIN ELLIS ON 6/28/90
I WATER MAIN CHG.
S.B.C.C. FEE 4.50
AOMOUNT DUE $311.50 THER FEES
DATE PAID 7a-6 " `fo AMOUNT a t I : 75 C- RECEIPT # I Z e 2- /
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 M IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND THE APPLICABLE CITY OF FEDERAL WAY
REQUIREMENTS WILL BE M .
OWNER ORA z..- _- DATE 2-6- C!J_
1
CITY OF BUILDING INSPECTION
FEDERAL WAY BUILDING PERMIT 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
ISSUED BY DATE OF ISSUE DATE OF APPLICATION
BUILDING INFORMATION
•NE 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 a.. UNIT HEATER TOTAL MECHANICAL AMOUNT
VALUATION i LANNING DEPT APPROVAL = NOT
APPLICABLE (NO CHANGE Iv
PERMIT FEE '5.00
PLAN CHECK FEE
0 SEPA 21, « %
PLUMBING FEE FI `i DEPT APPROVAL KEVIN ELLIS ON 4/29/90
CHANICAL FEE
TAL BLDG. FEES PUBLIC WORKS APPROVAL = NOT APPLICABLE
PART P/C FEE
SEPA REVIEW / f
WATER SERVICE BUILDING G M?;P ` APPROVAL = KEVIN ELLIS O1 6! 28/ X9'0
WATER MAIN CHG.
S.B.C.C. FEE _
OTHER FEES -
' ��3 � .. � �� ) (� �,..;-tt+.� ...fir: * t r G....
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
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RECEIVED
Omit #
JUN21 i99)1
CITY OF FEDERAL WAY C. A
CITY OFFEDERALWAY BUILDING PERMIT APPLICATION
BUILDING DEPT. —Please Print—
BOX 1 TENANT NAME:TWIN LAKES CHIROPRACTIC CENTER
OWNER BMS JOINT TENANCY C/O GARY STRODTZSITE LOCATION 2500 E S.W. 336TH,
OWNER'S ADDRESS 133 23RD STREET S.E. CITY PUYALLUP PHONE 848-8688
DESCRIBE JOB LEASE HOLD IMPROVEMENTS
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP ` XX CORPORATION
BOX 2 CONTRACTOR'S NAME SHINSTINE / ASSOC. INC. CONTRACTOR'S REG. # SHINSI*107CZ
Card MUST be presented
CONTRACTOR'S ADDRESS P.O. BOX 1027; 2732 E. MAIIITY PUYALLUP PHONE840-1770
EXPIRATION DATE DECEMBER 1990
— OR —
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 LARRY HANSEN PHONE 83-3777
BOX 4 SEWER DISTRICT 4 WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST 35,000.00 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 132103-9096-03
.
LEGAL DESCRIPTION SOT 2, UNDER KING RECORD #7904230952 AND REVVISED UNDER KING COUNTY #
8104290296 AND 8501140624
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR /5az- / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE D�PiN
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
t 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 $
DRAINS $
OTHER _ $
TOTAL FIXTURES _ $
?(S- - (O,c?b TOTAL MECHANICAL FEE $ jav
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 A ACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART 9F THIS APPLICATION.
j
OWNER/AGFiN' ^---` /�/ ---T---------- DATE: 627O
ANP-008 3/90
•
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW THIS LINE)
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
REMARKS:
14/74- CJ/ Q ( V US la O C C C,
rr
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DATE
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL ,1///1 DATE
REMARKS: 1V
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. )C OTHER
OCCUPANCY t> 2 TYPE OF CONSTRUCTION t14/ STORES
jck— BUILDING SQ. FT. 16 ! i- @ ,Go = 8(567. Zc�
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. �
BUILDING SQ. FT. @ A&c(k TV4 ✓ 0
TOTAL SQ. FT. TOTAL VALUATION 1G 3 3 ` K `J
BUILDING DEPARTMENT REMARKS: PERMIT FEE (0Or c'�
PLAN CHECK FEE //7, d a
PLUMBING FEE /D
MECHANICAL FEE U
TOTAL BLDG. FEES 30? , o c
PART P/C FEE
SEPA REVIEW G
S.B.C.C. FEE `C-R'
OTHER FEES )D 0 O
AMOUNT DUE 3 / ( 5 r
41 D 7yb� Z ASSIGNED ADDRESS: S� e-?( ( S` 1A-1
66!! yd 0e
(1 `cN'it -4/0 PARTIAL PLAN CHECK FEE RECEIVED
Amount Date Receipt#
BUILDING DEPARTMENT APPROVAL
RECEIVED BY DATE - ACCEPTED FOR FILING