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05-100087City of Federal Way Community Development Services P.O. Box 9718 Federal Way, W , 98063-9718 Ph: (253) 835-7000 Fax: (253) 835-2609 s Building - Single Family Permit #: 05 - 100087 - 04 = SF G Inspection request line: (253) 835-3050 Proj, c'.:`?ame: MURK Vy Project Address: 29652 18TH AVE S Parcel Number: 367440 0130 Project Description: NEW - New 2824 square foot home with plumbing and mechanical. *REVISION: Alternate design - 2,080 sf w/400 sf garage.* Owner Applicant Contractor Lender Bernard J Murray & Karen E Murray BK BUILDERS BK BUILDERS STERLING SAVINGS BANK 5648 S 3324TH PL 5648 SW 324TH CT BKBUIB*952BL 02/2/05 1700 SW 320TH ST AUBURN WA AUBURN WA 98001 5648 SW 324TH CT FEDERAL WAY WA 98003 98001 AUBURN WA 98001 Includes: ensus category_ 101 -New si Dccupaitcy.Group: #1 R-3 #2 U-1 #3. #4. Construction Type: Occupancy Load: Type V.- N Type V - B y.. Y Floor Area (Sq. Ft.): 1st Floor Proposed Sq. Feet ................................. 1160 2nd Floor Proposed Sq. Feet ................................ 1040 Basic Plan ................................................. No Census Category-. ............................. :................. 101 -New single family hous( Occupancy 92 - Construction Type ............ :......... Type V - B Fire Sprinklers Required ...................................... No Garage Proposed Sq. Feet....................................400 Height of Structure ................. ........ I ........ ......... 23 Mechanical ....................... .......................... Yes Occupancy 41 - Class.......................................... R-3 Occupancy #2 - Class .......................................... U-1 Plumbing ................................................. Yes Total Building Sq. Feet........................................2600 Total Proposed Sq. Feet ...... ...................... I .......... 2600 Zoning Designation... ........... _ .......... .... RS 7.2 Plumbing Fixtures Description Quasi Description _ Quanti _ Description �_Quanti Bathtubs 1 Dishwashers 1 Gas Pipe Outlets )Laundry her Outlets Lavatories 3 Other Plumbing Fixtures 2 Showers _ 1 Sinks 1 Water Closets fir-- nJ Water Heaters I i Mechanical Fixtures Description +Quanti Description __6anfipjr Descripticn —� Quan i � Fans 3 Ranges 1 CONDITIONS: 1)The driveway shall be paved per FWCC, Sec. 22-1453. The driveway shall be paved for a distance of 40' starting from the existing roadway pavement edge. 2)Maximum driveway width is 10 feet. 5' setbacks required on each side. 3)Service connections for electrical & communication facilities shall be placed underground per FWCC, Sec. 16-48. 4)Prior to any clearing or grading on a lot, the owner/builder shall install temporary erosion/sedimentation control facilities approved by the City. These facilities must ensure that dirt or sediment laden water does not enter the public drainage system, adjacent lots or public streets. The owner/builder bears the responsibility to maintain the facilities in proper working order, replacing as necessary. The facilities may be removed only after such time as construction is complete & landscaping is installed. See attached for standards and site plan for location of silt fencing. PERMIT EXPIRES April 26, 2006. Permit issued on October 28, 2005 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 accordance with the laws, rules and regulations of the State of Washington and the City of Federal W�ay� A Owner or agent. 1 Date: M — �- City of ede al Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.3 of the Uniform Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: MURRAY Address: 29652 18TH C Permit number: 05 - 100087 - 01 #1 #2 #3 #4 Occupancy Group: R-3 U-1 Construction Type: Occupancy Load: Type V - N Type V - B Floor Area (Sq. Ft.): Owner Bernard J Murray & Karen E Murray Name: 5648 S 3324TH PL Address: AUBURN WA 98001 Building Official Date AL priorily focus sit fire review and hrapectitm made by the City prior io issuance afthta Cer9ifrate was on Chase mauerr wlrtch experience hut.rilown most severely q�ect the health and safety of thegenerdprr6lic. Although tits City has made as complete a review and inspection as is reasonablypovsible (within budgetary time and parawmel ltnurvilons), the City neither guaramaes iior warrants to the owner/occupwo or to any orherperswr that this Certificate evidences strict compliance with each and every ordinmice or regulation of the City or the State of Washtngimr affecting the construction or use ofsatd.uruciure or fire livid upon which it is situated Such compliance vt die responsibility of the owner and/or occupant of the premises. City of Federal Way Community Development Services Building - SingleFamily Permit #: 05-100087 - 00 Sr P.O. Box 9718 Federal Way, WA 98063-9718 Ph: (253) 835-7000 Fax: (253) 835-2609 Inspection request line: (253) 835-3050 d Project Name: MURRAY Project Address: 29652 18TH AVE S Parcel Number: 367440 0130 Project Description: NEW - New 2824 square foot home with plumbing and mechanical. Owner Applicant Contractor Lender Bernard J Murray & Karen E Murray BK BUILDERS BK BUILDERS STERLING SAVINGS BANK 5648 S 3324TH PL 5648 SW 324TH CT 1 BKBUIB*952BL 0212/05 1700 SW 320TH ST AUBURN WA AUBURN WA 98001 5648 SW 324TH CT FEDERAL WAY WA 98003 98001 1 AUBURN WA 98001 Includes: Census category: 101 - New si Occupancy Group: Construction Type: Occupancy Load: Floor Area (Sq. Ft.): #1 R-3 #2 U-1 #3 #4 T eV-N TypeV -N 1 st Floor Proposed Sq. Feet ................................. 1977 BasicPlan ................................................. No Occupancy #2 - Construction Type ..................... Type V - N Fire Sprinklers Required......................................No Height of Structure .............................................. 16 Occupancy #1 - Class .......................................... R-3 Plumbing........,, ....................................... Yes Total Proposed Sq. Feet.......................................3799 2nd Floor Proposed Sq. Feet................................947 Census Category ................................................. 101 - New single family hous( Deck Proposed Sq. Feet.......................................184 Garage Proposed Sq. Feet....................................791 Mechanical ................ — .......................... .... Yes Occupancy #2 - Class .......................................... U-1 Total Building Sq. Feet........................................3638 Zoning Designation ............................................. RS 7.2 Plumbing Fixtures Descri tit7n IQtl_anti Description Quanti Description jQuanti Bathtubs 2 Dishwashers 1 Gas Pipe Outlets 6 Laundry Washer Outlets 1 Lavatories 5 Other Plumbing Fixtures t Showers 1 Sinks 2 Vacuum Breakers 1 � Water Closets 3 Water Heaters I Mechanical Fixtures Description lQuanti Descrip#ion �'Quanti BBQs 1 aescri tion Fans I lQuanti 4 Air Handling Units 1 Fireplace Inserts 1 Furnaces 1 Ranges CONDITIONS: 1)The driveway shall be paved per FWCC, Sec. 22-1453. The driveway shall be paved for a distance of 40' starting from the existing roadway pavement edge. 2)Maximum driveway width is 10 feet. 5' setbacks required on each side. 3)Service connections for electrical & communication facilities shall be placed underground per FWCC, Sec. 16-48. 4)Prior to any clearing or grading on a lot, the owner/builder shall install temporary erosion/sedimentation control facilities approved by the City. These facilities must ensure that dirt or sediment laden water does not enter the public drainage system, adjacent lots or public streets. The owner/builder bears the responsibility to maintain the facilities in proper working order, replacing as necessary. The facilities may be removed only after such time as construction is complete & landscaping is installed. See attached for standards and site plan for location of silt fencing. .' . a PERMIT EXPIRES October 24, 2005. Permit issued on April 27, 2005 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 accordance with the laws, rulers and regulations of the State of Washington and the City of Federal Wjiy.,,/ r% Owner or agent: t Date: City of Federal Way Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.3 of the Uniform Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: MURRAY Address: 29652 18TH S Permit number: 05 - 100087 - 00 #1 #2 #3 #4 Occupancy Group: R-3 U-1 Construction Type: Type V - N Type V - N Occupancy Load: Floor Area (Sq. Ft.): Owner Bernard J Murray & Karen E Murray Name: 5648 S 3324TH PL Address: AUBURN WA 98001 Building Official Date The priorityfocus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severely affect the Health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible (within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. THIS CARD IS TO RT,MAIN ON -SITE CITY OF Community. Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 05-100087-00-SF Owner: BERNARD J MURRAY Address: 29652 18TH AVE S FEDERAL WAY, WA This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On -going inspections are logged on the back of this card. ❑ Temp. Erosion Control (4365) ❑ Footings/Setback (4110) ❑ Foundation Wall (4115) To be done prior to breaking ground Approved to place concrete Approved to place concrete By e,- 5 Date Z •1-o By G,C13 Date - Za By C_ Z.A) Date C - 3-- O ❑ Drainage/Downspout (4040) ❑ Plumbing Groundwork (4190) ❑ Slab/Concrete Floor (4255) Approved to backfill Approved to cover Approved to place concrete By li C j Date !/ le) ..6 4p By Date By Date ❑ Underfloor Framing (4285) App�ovcd to sheath floor By DateZ /- Q Roof Sheathing (4220) Approved to install roofing By ,�_A3 Date p� ❑ Gas Piping (4125) Approved to release test By Date ❑ Framing (4120) Approved to insulate By Date (% S 6 ❑ Floor Sheathing (4105) Approved to install flooring By Date d__00_6 Rough Plumbing (4230) By�Approved Date 7j ❑ Fire/Draft Stops (4095) Approved By Date iJ�p ❑ Insulation (4150) Approved to install wallboard By FC9 Date ❑ Final - SWM (4375) ❑ Final - Mechanical (4065) Approved Approved By Date By Date [� Final - Building (4050) ❑Temp. Erosion Maintenance (4370) Approved /y Approved By Date p�"l By Da ❑ Shear Walls (4245) Approved to install siding By �G Date / 0(1 Mechanical Rough -in (4165) Approved t Date C W NOTE: Prior to scheduling a Framing 0120) inspection; Electrical, Plumbing & Mechanical Rough -in and Fire/Draft Stop inspections must be signed -oft' and approved. IBC 109.3.4/UBC 108.5.• ❑ Gypsum Wallboard Nailing (4130) A proved to install mud S &tope fir: ir� By Date ❑ Final - Plumbi g 4 7 Approved By Date This is an overview of possible fees associated with the issuance of permits and is not intended to be inclusive. PERMIT FEES Building, mechanical, and fire prevention system fees are based on the following schedule. -.Electrical and plumbing fees are calculated separately ** TOTAL PROJECT VALUATION INCREMENTAL FEE FACTOR (1) $1.00 to $500.00 (1) $30.50 (2) $501.00 to $2,000.00 (2) $30.50 for the first $500.00 plus $4-00 foreadi additional $100-00 or fraction thereof, to and including $2,000.00 (3) $2,001.00 to $25,000.00 (3) $90.50 for the first $2,000.00 plus 18 40 for cacf�gddr_tionet $1 000-00 or fraction thereof, to and including $25,000.00 (4) $25,001.00 to $50,000.00 (4) $504.50 for the first $25,000.00 plus 5l3-Op rareach or fraction thereof, to and including $50,000.00 (5) $50,001.00 to $100,000.00 (5) $829.50 for the first $50,000.00 plus $9.00 rareach addfllanal-$).000.00 or fraction thereof, to and including $100,000.00 (6) $100,001.00 to $500,000.00 (6) $1,279.50 for the first $100,000.00 plus $7.50 for each Additional P.000-00 or fraction thereof, I to and including $500,000.00 (7) $500,001.00 to $1,000,000.00 (7) $4,279.50 for the fiat $500,000.00 plus $6.001or each additional $1,000.00 or fraction thereof, to and including $1,000,000.00 (8) $1,000,001.00 and up (8) $7,279.50 for the first $1,000,000.00 plus $4.50 for each addi[ional$1,000.00 or fraction thereof. Table A PLAN REVIEW FEES • Building Permit 65% of Building Permit Fees • Mechanical Permit 25% of Mechanical Permit Fees • Plumbing Permit 65% of Plumbing Permit Fees • Additional Building Division Review $61.00/hour PLUMBING PERMIT FEES • $26.50 Permit Fee plus $9.50 per fixture OTHER FEES (Vary according to project type and scope) • WA State Building Code Council (SBBC) Surcharge • Fire District #39 review fees (commercial only) • Public Works review fees • School District Impact Fees (new residential only) • Demolition Permit Fees • Required Bond(s)/Deposits $4.50/issued permit 15% of Building Permit Fees Hourly/varies by project $3,269.00/single family residence $ 940.00/multi-family unit If you need assistance completing the permit application form, or have questions concerning the application process, please contact - Community Development Customer Service Counter at (253) 661-4115 8:00 am to 5:00 pm, Monday through Friday Bulletin # 100 - March 30, 2004 Page 4 of 4 L\Handouts - Revised\Permit Application 4 nrr or ■P�- Federal Way COMMUNITY DEVELOPMENT SERVICES 33325 8'H AVENUE SOUTH • PO BOX 9718 FEDERAL WAY, WA 98063-9718 253-835-2607• FAX 253-835-2609 �uout. dtrroflcdcmlu�y-mm The following is require PERMIT APPLICATION 3 CQ ME EL PL DE EN FP -an incomplete application will not be accepted. Please or SITE ADDRESS Arc S Fe- d w i4 SUITE/UNIT # ASSESSOR'S TAX/PARCEL # -3-7 �� / - f 3 0 9 ^� LOT SIZE (so 1 1; 13� LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ��' i' 14 44 I Lk ej j 5 h e e 1 IQ`5 7, 2- (Anarh s mate page far lengthy legal description) _ TYPE OF PERMIT W'BUILDING VPPLUMBING 04BANICAL ❑ DEMOLITION [VLECTRICAL ❑ ENGINEERING &J'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this permit only) t' nJ s `f r .l ! a 69 a V St, �' r 1 w L) 3 v S 4, L. PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER CONTRACTOR APPLICANT I NAME PRIMARY PHONE ►3 e,^ uV-�Q %`'I vKy -( (�s3)7 7 MAILING ADDRESS CITY, STATE, ZIP p S 3.;? y '�`' �L, '04 L.,L.' ,l' COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS 5- (a yPS 3ay�h /J�- CITY, STATE, ZIP Avb4-,r^/ WA 17Pn(:)i CELL PHONE ( 1 - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION DATE 6 k !3 lz 1 0 .* i S � !�_ va io,2 1a00s COMPANY NAME APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe) FAX NUMBER CONTACT NAM/EE O e eJ M cJ LENDER ` Per f2CW 19.27:095r Lender fnfarvia2V*rn is i required ifproject value exceeds $5.000 ()L P.P7 - / 77 - NAME j 7/e /' /,I rtJ t ,Sta ✓ � vt� S � � � CITY. STATE, ZIP 9 a-c-0C53 EXISTING USE V C fry ) PROPOSED USE +\� �oc tn� i t @ EXISTING ASSESSED/APPRAISED VALUEy S, d 0 VALUE OF PROPOSED WORK $ SPRINKLERED BUILDING? Zd�FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? �S ❑ NO WATER SERVICE PROVIDER ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER 9( LABEHAVEN ❑ ffiGHLINE ❑ PRIVATE (SEPTIC) Y3AREA. DESCRIPTION EXISTING S . FT. ASE FIRST SEC NO D THIRD FOURTH ADDITIONAL FLOORS (DESCRIBE) DECK (COVERED?) GA GEJCARPORT HOW MANY FLOORS? n TOTALr-'asTDrG -NEWHOMES ONLY** NUMBER OF BEDROOMS �_ ESTIMATED PRC._ .USED SQ. FT. 977 y/V7 TOTAL PROPOSED Cl TOTAL 77 t:�9 r- TOTAL EMSTMG A.CD PROPOSED Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. Rl.r+L.iuAsra- Value of Mechanical Work AIR HANDLING UNITS EVAPORATIVE COOLERS BBQS _ FANS BOILERS / FIREPLACE INSERTS COMPRESSORS / FURNACES DUCTS GAS PIPE OUTLETS _ BATHTUBS (-Tub/Sh-rCombo) SHOWERS / DISHWASHERS �_ SINKS - Cp GAS PIPE OUTLETS SUMPS WASHING MACHINES URINALS �! LAVS ris- • :: ••m S-k,1 I VACUUM BREAKERS GAS LOGS HOODS (Co-rdal) / RANGES / GAS WATER HEATERS 3 WATER CLOSETS troa�q DRINKING FOUNTAINS RAINWATER SYST _;3 HOSE BIBBS REFRIG. SYSTEMS WOODSTOVES MISC (Describe) f certify under penalty of perjury that the information furntshed by me is true and correct to the best of my knowledge, and furthe , that I am authorized by the owner of the above premises to perform the work for which the permit application is made. f further agree to hold harmless the City of Fedcral Way as to any claim (including costs, expenses, and attorneys' foes Incurred in the irtuestigorUon and defense of such cict", 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, facluding its officers and employees, upon the accuracy of the information supplied to the city as a part of this application. NAME/TITLE C'w a >• DATE (Signature) 17 t1i mdel RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent XContractor ❑Architect ❑Other FOk OFFICE USE ONLY a NEW a ADDITION BUILDING SHELL ONLY? ZONING DESIGNATION NEW ADDRESS REQUIRED? PLATTED LOT? Bulletin # 100 - March 30, 2004 t ❑ ALTERATION ❑ REPAIR ti TENANT IMPROVEMENT ❑ YES o NO BASIC PLAN? 6 YES ❑ NO CHANGE OF USE? o YES ❑ NO o YES ❑ NO UP/$EPA/SU? ❑ YES ❑ NO ❑ YES o NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO f Page 2 of 4 k\Handouts - Reviscd\Pcrmit Application RESIDENTIAL COMMERCIAL NEW RESIDENTIAL SERVICE NEW COMMERCIALIINDUSTRIAL SERVICE Service or Feeder Each Add'n ❑ Single Family Square Feet ❑ 0 100 amp $ 50 $ .00 (First 1300 ft2- $87.00; Each add'n 500. W - $28.00) f ❑ Detached outbuilding or garage ❑ 101 - 200 amp 117.17. 50 74.00 (Inspected with service) $ 36.50 ❑ 201 -400 amp 220.50 87.00 ❑ Detached outbuilding or garage ❑ 401 - 600 amp 256.50 103.00 (Inspected separately) $ 58.00 ❑ 601 - 800 amp 332.00 140.50 NEW MULTI -FAMILY (three units or more) ❑ 801 - 1000 amp 405.50 169.50 Service Feeder ❑ Over 1000 amp 442.00 236.00 ❑ Up to 200 amp $ 94.50 $ 28.00 ❑ Over 600 volts surcharge $74.00 ❑ 201 - 400 amp 117.50 58.00 ❑ Mast or meter repair $80.00 ❑ 401 - 600 amp 161.00 80.00 ❑ 601 - 800 amp 206.00 110.00 ALTERED COMMERCIAIJINDUSTRIAL ❑ Over 800 amp 294.50 220.50 Service or Feeders ❑ 0 to 200 amp $ 94.50 ALTERED SINGLEIMULTI FAMILY ❑ 201 - 600 amp 220.50 Service or Feeder ❑ 601 - 1000 amp 332.00 ❑ 0 to 200 amp $ 72.50 ❑ over 1000 amp 369.50 ❑ 201 - 600 amp 117.50 ❑ over 600 amp 177.00 ❑ # of circuits to be added/altered (1-5 circuits - $74.00; Add'n circuits, $6.00/ea) ❑ # of circuits to be added/altered COMMERCIE WINDUSTRIAL PLAN REVIEW (1-4 circuits-$58.00; Add'n circuits $6.00/ea) $ 74.00 plus 35°/D of Permit Fee Cl Mast or meter repair $ 43.50 ❑ Service over 200 amps ❑ Medical/Educational/Institutional Facility SINGLE/MULTI FAMILY PLAIN REVIEW ❑ Service Over 400 amps $ 74.00 plus 35% of Permit Fee MOBILE HOMES ❑ Service or feeder only $ 58.00 TEMPORARY SERVICE ❑ Service and feeder $ 94.50 Commercial Residential -- C� � MOBILE HOME RV PARR O - 100 $ 58.00 s4" ` • ❑ # of service or feeders ❑ 101 - 200 74.00 51.00 .(First service/feeder-$58.00; each add'n-$37.50) ❑ 201 - 400 87.00 n/a Cl 401 - 600 117.50 n/a ❑ over 600 127.00 n/a MISCELLANEOUS SERVICE/EQUIPMENT ❑ # of Thermostats ❑ # of Signs (First-$43.50; add'n-$13.50/ea) (First sign-$43.50; add'n sign $20.50/ea) ❑ Low Voltage ❑ Swimming pool/hot tub ................ $87.00 Square Feet to be served by system(s) (Includes additional circuit, it required) ❑ Fire Alarm System ❑ Yard Pole meter loops ..................... $58.00 ❑ Security Alarm System ❑ Additional Plan Review $87.00/hour ❑ Voice Cabling (for modified submittals) ❑ Data Cabling 11 (Per System(s) 1- 2500 ft2-$S 1.00; Each add'n 2500 ft2-13.501 ' Per WAC 296-46-9/0(5)(b)(i Be ii) Bulletin # 100 - March 30, 2004 Page 3 of 4 k\Handouts - Revised\Permit Application AREA DESCRIPTION EXISTING PROPOSED TOTAL S . FT. S . FT. SO. FT. BASEMENT FIRST / O O SECOND T(L `0 7 0OX THIRD FOURTH ADDITIONAL RS (DESCRIBE) DEA CovERED?j 1.2- / GARAGE ❑ CARPORT ❑ L%75r11[6 -arid: NUMBER OF FLOORS PROM = Toro. :i.. •. • w **NEW HOMES ONLY" NUMBER OF BEDROOMS S ESTIMATED SELLING PRICE � � a �� � � t ) Indicate number of each type of fcxiure to be installed or relocated as part of this project. Do not include existing fixtures to remain. XBCHANICEiL Value of Mechanical Work $4cn—(:)-- AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS REFRIG. SYSTEMS BBQS 3 FANS HOObs{cewmercialj WOODSTOVES BOILERS FIREPLACE INSERTS ; RANGES MISC (Describe) COMPR9S'SO9S ItRNACES [SAS WATER HEATERS DUCTS GAS PIPE OUTLETS PL[7 MIND I BATHTUBS (or Tub/ShomrCombo) l SHOWERS 3 WATER CLOSETS fruneq MISC (Describe) DISHWASHERS �_ SINKS DRINKING FOUNTAINS GAS PIPE OUTLETS SUMPS RAINWATER SYST I WASHING MACHINES URINALS HOSE BIBBS 3 LAVS (aazi, -sick:] VACUUM BREAKERS ELECTRIC WATER HEATERS I Certify under penafty of perjury that the Wormaiton furnished by me is true and correct to the hest 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 lurrrnless the City of Federal Way as to any cfafm !including costs, expenses, and attorneys' fees incurred in the Investigation and defense of such etalrrq which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only where such claim crises out of the reliance of the city, including its officers and employees, upon the accuracy of the ir4formaitan supplied to the city as a part of this application. NAME/TITLE DATE {Slg�a[ure� [TitEc� RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other �J ,n W Bulletin #100—Januaiy 7, 2005 Page 2 of 4 k\HandoutslPermit Appli r a� o v' I.. tC rn cd U Q $.. 4-4 O O �. a� .� S V] Ln � b d a b 3 � EnU S 4-1 �+ CA 0 o s A O p 0 S + �O 0 H N cC v cd 3 0 Go � 95 cd y 1-4 a s a 8 M 05-l000T7= cr r-Zr �- -� a ,i r s) s' Ivy ✓t f _ t I 1 1 .� Lj Ll cp cl os i f _.. - , iLvd SCALE". ) tI - , APPROVED .: DATE:2- 9 50 /9 Avr-- S, DRAWN BY REVISED DRAWING NUMBER