04-100938 City
onmunyDevelopment Services B •
in - Single Family Permit #: 04 - 100938 - 00 - SF
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: MIEDEMA
Project Address: 37095 5TH AVE SW Parcel Number:218820 2200
Project Description: ADD-540-square foot,2-story addition to an existing single-family home,including mechanical.No
plumbing.
Owner Applicant Contractor Lender
Scott A Miedema &Joanne Miedema RENEWAL CONSTRUCTION RENEWAL CONSTRUCTION Scott A Miedema
37095 5TH AVE SW RENEWAL CONSTRUCTION INC RENEWCI995NW 8/16/04 37095 5TH AVE SW
FEDERAL WAY WA 17404 MERIDIAN E#F-129 RENEWAixCONSTRUCTIONINC FEDERAL WA'.WA
98023-7347 PUYALLUP WA 98375 17404 MERIDIAN E#F-129 198023-7347
Includes:
Census category: 434-Reside �� #3 #4
Occupancy Group ° R 3 j (
Construction Type: A Type V N T��–s---a- I[
_ -- --
Occupancy Load ___...4 — ----i ------- 1
Floor Area(Sq.Ft.): I l
1st Floor Proposed Sq.Feet 352 2nd Floor Proposed Sq.Feet 188
Census Category 434-Residential alt/add-no Height of Structure \23
Mechanical Yes Occupancy Group#1 R-3
Plumbing No Total Building Sq.Feet 1800
Total Proposed Sq.Feet 540 Zoning Designation RS 7.2
Mechanical Fixtures
Description liQuantitylDescription -Quantity Description Quanti y
( Ducts 1 �l Woodstoves _IL_ 1 j
it
CONDITIONS:
kNo building shall encroach onto any building setback line or easement shown or not shown.
Prior to any clearing or grading on a lot,the owner/builder shall install temporary e Psion/se. •nt41i facili 'es
approved by the City.These facilities must ensure that dirt or sediment laden water • •s • ente drain ' •
system,adjacent lots or public streets.The owner/builder bears the responsibility to oo •ain the f. , - i • c,' +
working order,replacing as necessary.The facilities may be removed only after s t .4 t• •s co ., on ' c, I; , • &
landscaping is installed.See attached for standards and site plan for location • • P 0 g.
Per FWCC,Sec.22-1133(4),eaves,chimneys or awnings,&similar elements t cture4 .' torn. , end beyond
the exterior walls of a structure may extend up to 18 inches MAXIMUM i#t i • •equired • • •tba . liT tionally,the
total horizontal dimensions of the elements that extend into a required y• 4 ding • • •ay • exceed 25% of the
structure's facade length from which the elements extend.
4 . , 4
This decision shall not waive compliance with future City of Federal des, •of. v elating to the
subject proposal. l
Prior to final inspections,the applicant must pave 5th Ave S i e, as• • er , u •d surfacing,and must
have the paving inspected and approved by the Public Works . .artm•nt. A '.g C .e • it is required. Please
contact Kathleen Messinger at 253-661-4127.
Prior to final inspections,the applicant must sign and notarize a 0 No-Protest Wa / . 'lease return th' to Ann Dower,
Public Works Dept. s.
Tie roof downspouts into existing roof drain system. qk
//t) dR914 417
•
'
f • PERMIT EXPIRES November 1,200. --
Permit issued on May 5,2004
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 accordanc- i the laws,rules and regulations of the State of Washington and
the City of Federal Way. /
/�
Owner or agent: • I' 711F. Date: S — 5 —O y
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POS THIS CARD ON THE FRONT OF BUILDING' +h1
c;r, ^F
Federal Way BUMS.ING DIVISION
INSPECTION RECORD
INSPECTION REQUEST PHONE#: 253-835-3050
PERMIT #: 04-100938-00-SF
OWNER'S NAME: Scott A Miedema & Joanne Miedema
SITE ADDRESS: 37095 5TH SW fjl
/' OfI&AJ G�oirTl 'C
O FOOTINGS/SETBACKS 5//d/t 5V �L� O �,�{j I FOUNDATION WAL, 7 0 4
DO NOT/POUR CONCRETE UNTIL THE ABOVE IS APPROVED
( ) DRAINAGE: Line ( ) Connection
DO NOT POUR SLAB UNTIL THE ABOVE IS APPROVED
( ) UNDERFLOOR FRAMING - in y
O ROUGH PLUMBING: DWV Water piping
( ) ROUGH MECHANICAL Gas piping7/ 10? "ar...
() SHEATHING Roof 119-C1194 110ii J Floor
( ) SHEAR WALLS ,, ,/4011/-
( )
, X01() ELECTRICAL ROUGH-IN Ditch Cover
( ) FIRE/DRAFTSTOPS
ALL THE ABOVE MUST BE APPROVED PRIOR
TO FRAMING INSPECTION
( ) FRAMING/FIRESTOPPING 7/i Zh q
THE ABOVE MUST BE APPROVED PRIOR TO INSULATING OR SHEETROCKING /� �j�
( ) INSULATION: Floors �1 Walls/ /i lls ��510 .�ttic 7//_5-
THE ABOVE MUST BE APPROVED PRIOR TO APPLYING SHEETROCK
() WALLBOARD NAILING ) SUSPENDED CEILING
THE ABOVE MUST BE APPROVED PRIOR TO TAPING OR INSTALLING CEILING TILE
() ELECTRICAL FINAL
() PLANNING FINAL
() PUBLIC WORKS FINAL
( ) FIRE FINAL
THE ABOVE MUST BE APPROVED PRIOR TO BUILDING DEPARTMENT FINAL
O BUILDING FINAL
DO NOT OCCUPY THIS BUILDING UNTIL BUILDING FINAL IS APPROVED
AltCOMMUNITY DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH•PO BOX 9718
CITY OF � �� FEDERAL WAY,WA 98 063-9 71 8
Federal Way PERMIT APPLICATION 253-661-411 ]AX:�53s61�129
e1ytX23- Com
For Office Use Only: taAY / q TD.
FW File Number [460-1.4,4_ Q C) 1 Z 12 C. ) ), °`t / , / 0)4
The ollowin• is re•uired in ormation-an incom•lete a.•lication will not be acce•ted. Please •rint le•ibl in ink or •e.
Ave, • PROPERTY INFORMATTION
SITE ADDRESS: 3`)0 C(5- 5 AS.U. l leveed 0SUITE/APT# /
ASSESSOR'S TAX/PARCEL #: a, ) U a.0 - O a 0 V SQUARE FOOTAx.
GE F LOT: la, OOC) S., W \I'�
LEGAL DESCRIPTION (e.g.:Acme Estates, Lot 1) ie
(Attach separate page for lengthy legal description)
• PROJECT INFORMATION
TYPE OF PERMIT(This application): R BUILDING ❑ PLUMBING fa MECHANICAL ❑ DEMOLITION
g ELECTRICAL ❑ ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only):
5 '1011 S . -11 .
Sto r AAA,-�r'oA
PROJECT NAME (Name of Business/Owner Last Name): clA i' r cVe rY4 0.
■ PEOPLE INFORMATION
PROPERTY NAME: ,,fes, 1 PRIMARY PHONE:
C
OWNER: J C_b/ / d----S—.0 c•`f A F. 1�1 e' mc`, ( ) t��c7 g-5(ak5
MAILING ADDRESS(STREET ADDRESS* CITY,STATE ZIP 1 /��, ' A
‘)07g5--' (
, ,1 T uCp V.W. lea♦/ Wt 9O3
CONTRACTOR: NAME C MPANY Li OFFICE PHONE:
G €v E>,C.€. _ e € j G.1 ( ) '?70- Sl z yG
MAILING ADDRESS(STR ET ADDRESS;): TY,STA ,ZIP CELL PHONE:
i?404/ P')erit arc i E. 4'1_14 P . kg., 0 LA `t�33% (a63) 61% - ro/3
C TY OF F DERAL WAY BUSINESS LICENSE NUMBER: E IRATION DATE: FAX NUMBER:
- - / / ( ' g4( -saw-)
CONTRACTOR'S REGISTRATION NUMBER: 1- EXPIRATION DATE:
(copy of card required with each application) 1` E, 6) f, WC £ G Gtr N 6 I// ! l 41 / 0 y
LENDER: NAME: 1 'f /�--� DAYTIME PHONE:
(If Proposed Values$5,000) / ) /} -, / I i/�nk,�, ( )
MAILING ADDI SS(STREET ADDRESS;):, CITY,STATE,ZIP
APPLICANT: NAME: (� COMPANY`-� OFFICE PHONE:
G e.0 r d-A9 e c et1J0..} (53) 090 -S1(9,
MAILING ADDRESS( ,ET ADDpRESS): J"'1 RCITY,STATE,ZIP EVENING PHONE:
•
REL TI NSHI TOPROJECT: (\ FAX NUMBER: /
CI Architect o Tenant ID Other(Describe): J (,a� S91 -sbe)
CONTACT PERSON FOR THIS PROJECT: ❑ Property Owner )Contractor 0 Applicant E-MAIL ADDRESS:
• DETAILED BUILDING INFORMATION
EXISTING USE: PROPOSED USE:
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK: $ ' D/COQ
SPRINKLERED BUILDING? ❑ YES p NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED?: ❑ YES o NO
WATER SERVICE PROVIDER: o LAKEHAVEN ❑ HIGHLINE n TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
• AREA DESCRIPTION EXISTING SQ.FT. PROPOSED SQ. FT. TOTAL
BASEMENT M
FIRST
6CTO 352 10q2.
2
SECOND / ? -s7
-6'70 • (JJ
•
THIRD M/
-
FOURTH P/A4
ADDITIONAL FLOORS(DESCRIBE) ,
DECK(COVERED?) '_ 1`�J ,1
GARAGE/CARPORT
��f y�jJOl
HOW MANY FLOORS? /
TOTNG TOTAL PROPOSED TOTAL EXISTING AND PROPOSED
**NEW HOMES ONLY** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
U FIXTURES
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL o2 14.0
Value of Mechanical Work $/ ) (4-0
AIR HANDLING UNITS EVAPORATIVE COOLERS MVO C3AS Ilitel4A;:epia4.e REFRIG.SYSTEMS
BBQS FANS HOODS)commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
/ COMPRESSORS FURNACES GAS WATER HEATERS
b DUCTS GAS PIPE OUTLETS
PLUMBING 104
BATHTUBS(or Tub/Shower combo) SHOWERS WATER CLOSETS(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYS
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sick VACUUM BREAKERS ELECTRIC WATER HEATERS
• 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 Feder t Way, but only where such claim arises out of the reliance of the city, including its officers
and employees, upon the a °racy o •e information supplied toottheGcity as a part of this application.
NAME/TITLE: - I/ � � /44-0 0,"- DATE: //ZG Zc1e1 V
�`�g-ature) (Title) /
RELATIONSHIP TO PROJECT: ❑ Property Owner 0 Applicant pontractor ❑ Architect 0
FOR OFFICE USE ONLY:
o NEW a ADDITION a ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES o NO
ZONING DESIGNATION: CHANGE OF USE? ❑YES o NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? o YES o NO
PLATTED LOT? o YES ❑ NO DEMO PERMIT REQUIRED? a YES o NO
Bulletin#100—January 13,2004 Page 2 of 4 k:\Handouts—Revised\Permit Application