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
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