93-101113 CIT" OF FEDERAL WAY BUILDING PERIVIIT
PERMIT NO..:: B%D9393-0 0488
33530 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 06/22/93
Federal Way, WA 98003 BY: JJ
661 -4000
SITE ADDRESS: 30619 16TH AVE SW
PARCEL NO.: 122103®9136
PROJECT DESCRIPTION: PARK UPGRADE ® GRADE & FILL
OWNERll CONTRACTOR LENDER
ADELAIDE PARK PAUL BROTHERS INC
33530 1ST WAY S 8655 SE REVENUE RD
FEDERAL WAY WA 98003 BORING OR 970099492
661-40184111 T.
503-663-1220
PAULBI239LG
1 BLD?: NEC?: PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 0 COMP PLAN .7 FEES:
TYPE OF WORK:ALT USE:PUB 1ST.: 0: 0:sf STORIES • 0 REQUIRED PARKING..: 0 SPRINKLERS? •? PUB WORKS-PLAN CHECK $ 80.00
CENSUS CATEGORY •625 2ND.: 0: O:sf HEIGHT • 0.00 ft HAZARD CLASS •7 FINAL PLAN CHECK...* $ 0.00
OCCUPANCY GROUP 3RD.: 0: O:sf VALUATION REQUIRED SETBACKS FIRE FLOW • 0 gpm PLUMBING FIXT....93* $ 0.00
:? :? :? :? OTHR: 0: O:sf EXIST..$: 0 FRONT • 0.00 ft GRADING PERMIT $ 0.00
TYPE OF CONSTRUCTION BSMT: 0: 0:sf PROP...$: 215517 SIDE • 0.00 ft WATER SERVICE..:?
:? :? :? :? DECK: 0: 0:sf REAR • O.00:ft SEWER SERVICE..:?
OCCUPANT LOAD GAR.: 0: 0:sf RECEIVED.:05/07/93
0: 0: 0: 0: TOTL: 0: O:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:?
FUEL TYPES.:? ? FANS • 0 BOILERS/COMPRESSORS WATER CLOSETS • 0 URINALS • 0 TOTAL FEES $ 80.00
GAS PIPING.: 0 ft HOOD • 0 0-3 HP • 0 BATH TUBS • 0 DRINKING FOUNT.: 0
FURN<100K..: 0 DUCT WORK • 0 3-15 HP • 0 SHOWERS • 0 SUMPS • 0
GAS HWT • 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: 1
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
GASLOGS...: 0 > 10,000 CFM: 0 UNDERGROUND.: 0
ALL PERMITS EXPIRE 180 DAYS AFTER ISSUANCE IF NO WORK IS STARTED. RESIDENTIAL AND GRADING PERMITS EXPIRE ONE YEAR AFTER DATE OF ISSUANCE.
It 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 -kri
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bld_prmt 10/23/92 /
SET BACKS AND FOOTINGS O.K TO POUR FOUNDATION WALLS PLUMBING GROUNDWORK
DATE _.__—...... BY BY DATE — BY
_.....-. DATE _._ —_....
PLUMBING ROUGH IN WATER LINE O.K. MECHANICAL INSPECTION
DATE __..- BY GAS PIPING O.K. _. _. _—__ DATE BY
O.K. TO ENCLOSE FRAMING INSULATION WALL BOARD AND FIRE WALL
DATE....... :Y .._. DATE ..... BY ._ DATE —_... BY
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LVED Pipit # 0 ,3 _ L(
MAY - 6 1993 CITY OF FEDERAL WAY
i Y W AYBUILDING PERMIT APPLICATION
BUIL — Please Print—
BOX 1 TENANT NAME: Adelaide Park
OWNER City of Federal Way SITE LOCATION 30619 16th Ave. SW, Feclora1 way
OWNER'S ADDRESS 33530 1st Way S. CITY Fedeal Way PHONE 661-4(148
DESCRIBE JOB Park upgrade project
THE PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME Paul Brothers, Inc. CONTRACTOR'S REG. # PAULBI*239LG
Card MUST be presented
CONTRACTOR'S ADDRESS 8655 SE Revenue Rd. CITY Boring, OR PHONE503-663-1220
EXPIRATION DATE 2/15/94
— 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 Barbara Simpson, Park Planner ffl�,,,.,,,,;o PHONE 661-4048
BOX 4 SEWER DISTRICT Federal Way WATER DISTRICTFederal Way
BOX 5 ESTIMATED PROJECT COST $215, 157 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUMBER 122103-9136-0
LEGAL DESCRIPTION
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR / BASEMENT / DECK / GARAGE /
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = ) ( ) EXISTING STRUCTURE
( ) COMMERCIALIINDUSTRIAL TOTAL AREA OF PROPERTY SQ FT
BOX 9 PLUMBING FIXTURES (including rough-ins) MECHANICAL APPLIANCES — BASIC FEE$
NO. WATERCLOSETS GAS PIPING, FEET $
BATHTUBS NO. FURNACE, ELEC. GAS $
SHOWERS GAS HOT WATER HEATER $
LAVATORIES CONVERSION BURNER $
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 $
TOTAL MECHANICAL FEE $
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: /!/���7DATE: S_ –
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