95-101030 1r95- io/0o
CITY OF FEDERAL WAY PERMIT NO: BLD95-0381
33530 First Way South BUILDING I T ISSUED: 06/08/95
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC2
661-4000 EXPIRES: 12/05/95
ADDRESS:620 SW 293RD ST
NO. : 119600-0310
PROJECT DESCRIPTION:RES ADD - ROOFING OVER A FLAT DECK.
1 OWNER = ==s====== ==-T= CONTRACTOR LENDER ====a
=a=STEVEN PEDERSEN E SIMS, R S
620 SW 293RD ST 3237 S 368TH PL
FEDERAL WAY WA 98023 FEDERAL WAY WA 98003
41-4359 838-3984
SIMS#RS1640F
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*** CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL WAY. TAX RATE = 8.2% sts
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BLD?:X MEC?: PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 0 COMP PLAN 0 FEES:
TYPE OF WORK:TEN USE:RES 1ST.: 0: 0:sf STORIES • 0 REQUIRED PARKING..: 0 SPRINKLERS' •' PLAN CHECK FEE $ 46.80
CENSUS CATEGORY •434 2ND.: 0: 0:sf HEIGHT • 0.00 ft HAZARD CLASS •1 BUILDING PERMIT....$ $ 72.00
OCCUPANCY GROUP 3RD.: 0: O:sf VALUATION REQUIRED SETBACKS FIRE FLOW • 0 gpm SBCC SURCHARGE * $ 4.50
:R3 :? :? :? OTHR: 0: 0:sf EXIST..$: 0 FRONT • 0.00 ft PUB WKS PLCK(SF)..93 $ 40.00
TYPE OF CONSTRUCTION BSMT: 0: O:sf PROP...$: 4300 SIDE • 0.00 ft WATER SERVICE..:FED
:5N :? :? :? DECK: 0: 0:sf REAR • 0.00:ft SEWER SERVICE..:FED
OCCUPANT LOAD GAR.: 0: 0:sf RECEIVED.:05/19/95
0: 0: 0: 0: TOTI: 0: 0:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:?
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FUEL TYPES.:? ? FANS 0 BOILERS/COMPRESSORS WATER CLOSETS • 0 URINALS • 0 TOTAL FEES $ 163.30
410
GAS PIPING.: 0 ft HOOD 0 0-3 HP 0 BATH TUBS 0 DRINKING FOUNT.: 0
URN<100K..: 0 DUCT WORK 0 3-15 HP • 0 SHOWERS • 0 SUMPS • 0
GAS HNT 0 WOOD STOVES...: 0 15-30 HP • 0 LAVATORIES • 0 VAC BREAKERS...: 0
CONV BURNER: 0 FURN>100K • 0 30-50 HP 0 SINKS • 0 DRAINS • 0
BBQ • 0 MISC 0 5+ •
HP 0 DISH WASHERS 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0
RANGE 0 <:10,000 CFM: 0 ABOVE GROUND: 0 LAUN WSHR OUTLTS...: 0
GAS L0GS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
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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 THEINFORMATION .1 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 lam_ ._ OF
DATE �; „c d ? ,5--
I 1,_
FILE COPY
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CITY OF FEDERAL WAYPERMIT NO: BLD95-0381
33530 First Way South BU I L.D I NG PERMIT ISSUED: 06/08/95
Federal Way, WA 98003 Building Inspection Requests 661-4140 BY: FC2
661-4000 EXPIRES: 12/05/95
ADDRESS:620 SW 293RD ST
NO. : 119600-0310
PROJECT DESCRIPTION:RES ADD - ROOFING OVER A FLAT DECK.
! OWNER ¢aama¢aa!!! !,=sxxaaaamaazstaamlllsaara¢rnaaaxa!¢a3¢ s CONTRACTOR =¢!t=alxlsa�z,xa an:aa.aaam_aaxaxcaac:_axaxa¢ a LENDER aaalaalra�aereaasaaCASMlaxslallcexam=aaa ,:aaxs>
STEVEN PEDERSEN SIMS, R S
620 SW 293RD ST 3231 S 368TH PL
FEDERAL WAY WA 98023 FEDERAL WAY WA 98003
iilo
,41-4359 838-3984
SIMS*RS1640F
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*** CONTRACTORS, PLEASE USE LOCATION CODE 1732 WHEN REPORTING SALES TAX FOR PROJECTS WITHIN THE CITY OF FEDERAL NAY. TAX RATE = 8.2% us
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BLD?:X NEC': PLM?: FLR--EXIST--PROP--- DWELLING MITTS. 0 COMP PLAN •7 FEES:
TYPE OF WORK:TEN USE:RES 1ST.: 0: 0:sf STORIES........: 0 REQUIRED PARKING .: 0 SPRINKLERS/ 0 PLAN CHECK FEE $ 46.80
CENSUS CATEGORY •434 2ND.: 0: O:sf HEIGHT...... 0.00 ft HADD(LASS..„:? r BUILDING PERMIT....* $ 72.00
OCCUPANCY GROUP 3RD.: 0: 0:sf VALUATION---------- I REQUIRED SETBACKS--- --- FIRE FLOW..... 0• ,�,, SBCC SURCHARGE * $ 4.50
:R3 :? :? :? : OM): O: 0:sf EYIST..$: 0 1 FRONT.........: 0.00 ft PUB $K$_PLCK(SF)..93 $ 40.00
TYPE OF CONSTRUCTIOW----1 BSMT: 0: 0:sf PROP...$: 4300 SIDE 0.00` ft WATER SERVICE..:FED ?
:5N :? :? :? .1k DECK: 0: O:sf REQ° • 0.00:ft SEWER SERVICE..:FED
OCCUPANT LOAD OAR.: 0: 0:sf RECEIVED.:O5/14/95
. 0: 0: 0: 0: ITh.: 0: 0:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:?
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FUEL TYPES.:? ? FANS • 4- BOILERS/COMPRESSORS WATER CLOSETS • 0 URINALS • 0 TOTAL FEES $ 163.30
S PIPING.: 0 ft HOOD • 0 0-3 HP • 0 BATH TUBS • 0 DRINKING FOUNT.: 0
RN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 SHOWERS • 0 SUMPS • 0
GAS HWT • 0 WOOD STOVES...: 0 15-30 NP • 0 LAVATORIES • 0 VAC BREAKERS...: 0
CONV BURNER: 0 FURN>100K • 0 30-50 HP • 0 SINKS • 0 DRAINS • 0
BBQ • 0 MISC • 0 5+ HP • 0 DISH WASHERS • 0 LAWN SPRINKLERS: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS 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
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PERNITS EXPIRE 180 DAYS AFTER ISSUANCE IF HO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUACE.
I CERTIFY THAT THE INFORMATION BY NE IS TRUE AND CORRECT TO THE BEST OF NY KNOWLEDGE AND THE AP ABLE CITY OF FEDERAL. WAY REQUIREMENTS WILL- HE NET.
OWNER OR AGENT _ r _ DATE _ f�.x(,Q`/___�Y lir
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RECEIVED City of Federal Way
MAArP�,[RATION FOR BUILDING PERMIT
CITY OF FEDERAL WAY
PLEASE PRINT BUILDING DEPT. ,` ^� _O�Q i
APPLICATION #: 3( D XJ r
SITE LOCATION Address y J c.;./.. r Euler/ wad wa, 9x0.3
Tenant (if known) Lot # Assessor's Tax #
(571€e(jekti krseK, qadKd/DI_ /d 0/9600- 0310 -o7
Building Owner Name Address
6.Iwew 7). 7)edetscyv Sao ,56D a93 Se., 9. raL Ct/o%Lv4 .. 970a3
City reel ked taz4 State(Q • Zip q joa3 Phone 9t/
Nature of Work k0of over et .I:%:/ deco
APPLICANT
Name (F,M,L)
t5-/eden> Pedersen,
Address
to 070 £A). c>293 ��+ .
City redeka' �.va State(la, Zip9,47.3
Con.t5ct Person Day Phone Other Phone Fax
ef CIV She ue, 9,//1/3 57 9a a eo z,
BUILDING CONTRACTOR
Company Name
R. S. Sims Con sir/4c Z-DA.
Address
34237 Sc. 342'4' Pi
City 1e df-kState 6JA,. Zip 9.'oo3
Contact Person ' Phone Fax
Dick, £%/ri5 8,3f-39g�
Contractor's #(card must be presented) Expiration Date Verified ❑ Yes ❑ No
S/tits- £5 /�5o F x/3 .96-
. ..... .................... ..
ARCHITECT
Name
Address
City
State Zip
Contact Person Phone Fax
LEGAL DESCRIPTION
L4+-5 q and lQ, Arlock JO and G.4gcrkoru oP b/otic 6 Iir,_ wi']l i'it k
ho l o u hm o4' side lmnrs of 10t y l/t /Ort /o, �'/7 751Mfill r o U aeeordiel
e ,��
+ el Ye( -doe in 1/a louNab 011 6(6rd5 a-F Kin 62,07 (.oa
TOr (.04 4i47 (a vtds GF / Sectmd c1 SS h tQ 1� I
fiNA
pro lan rceiv X/ 9-it-tot/Ai Ld 0-4 5 (66 �o.
Please Complete Reverse Side
CD0492(Rev 4/93)
�'I,RUC"PURE ting Use oSlhCf/G •4 /Y �Ld/)tG *posed Use
t1 Permit includes: g Building 0 Plumbing 0 Mechanical ❑ Other
Type of Work: 1 Residential 0 New ❑ Remodel ❑ Number of Units ❑ Deck
El Commercial ❑ Addition ❑ Garage ❑ Shed Other pdeloveydeck
Enter 1st Floor /4 50 sq ft 2nd Floor /30o sq ft 3rd Floor sq ft Existing Floor Area c 9 3 O sq ft
Area Basement sq ft Decks sq ft Garage sq ft Proposed Total Area a93O sq ft
Water Availability Sewer Availability CV. On-Site Septic System Availability ❑ Project Valuation $ /3 00. 00
ZoningCJih,tt (4 Lot Size5'Q x 170 -o x 5 x /55 t• Existing Bldg Valuation $ 38500 00
LENDER
Name Address
OW/UK
City State Zip
MECHANICAL CONTRACTOR
Contractor Name Address
City State Zip
Contact Phone Fax
License # piration Date Verified ❑ Yes El No
r
r1
PLUMBING CONTRACTOR 1
\ 11
Contractor Name \�J1, Address
City ' State Zip
Contact Phone
Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT
Water Closets inks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washing Machine Drains Total Fixture Count
...................... ....... ....... .
............................... ...........
.....................
MECHANICAL:UNIT: QU1 IT
Fuel Type (electric/' her) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas l'''sing Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100 :TUs Gas Log Unit Heater 50+ Tons
Furn >19* 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 Total Unit Count
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 investig tion 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 f liance 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: � ' iLK-4>L4.-e-',1(../ Date 1_l! 4 /y