92-101371CI E'Y OF FEDERAL WAY BUILDING PERMIT
325:0 First Way South BUILDING INSPECTION - 661-4140
Federal Way, WA 98003
661 4000
SITE ADDRESS: 1851 SW 304TH ST
PARCEL NO.: 122103-9161
PROJECT DESCRIPTION: TWO STORY ADDN: 2 BEDROOMS UPPER LEVEL AND WORKROOM LOWER LEVEL
OWNER CONTRACTOR LENDER
LIND SIMONSEN, JR *OWNER IS CONTRACTOR*
1851 SW 304TH STREET
FEDERAL WAY WA 98023
927-3156
BLD?:X MEC?:X PLM?:
TYPE OF WORK:ADD USE:RES
CENSUS CATEGORY ..... :434
OCCUPANCY GROUP ----------
:R3
TYPE OF CONSTRUCTION-----
:5N
OCCUPANT LOAD ------------
. 0: 0: 0: 0:
FUEL TYPES.:GAS ?
GAS PIPING.: 0 ft
FURN<100K..: 0
GAS HWT.... : 0
CONV BURNER: 0
BBQ........ . 0
GAS DRYER..: 0
RANGE 0
LZAP-1-OGS
.. 0
FLR--EXIST--PROP---
1ST.:
0:
371:sf
2ND.:
0:
371:sf
3RD.:
0:
O:Sf
OTHR:
0:
O:Sf
BSMT:
0:
O:Sf
DECK:
0:
O:Sf
GAR.:
0:
O:Sf
TOTL:
0:
742:sf
FANS..........: 0
HOOD..........: 0
DUCT WORK.....: 1
WOOD STOVES...: 0
FURN>100K..... : 0
MISC..........: 0
AIR HANDLING UNITS
<=10,000 CFM: 0
> 10,000 CFM: 0
*OWNER*
DWELLING UNITS: 1
STORIES........ 2
HEIGHT.....: 0.00 ft
VALUATION ----------
EXIST..$: 0
PROP ... $: 48320
RECEIVED.:08/26/92
BOILERS/COMPRESSORS
0-3 HP......: 0
3-15 HP.....: 0
15-30 HP....: 0
30-50 HP....: 0
5+ HP........ 0
FUEL TANKS ---------
ABOVEGROUND: 0
UNDERGROUND.: 0
COMP PLAN.........:?
REQUIRED PARKING..: 0
REQUIRED SET86CKS-------
FRONT.......... . 20.00 ft
SIDE........... 5.00 ft
REAR..........: 5.00:ft
IMPERV
WATER CLOSETS......:
BATH TUBS...........
SHOWERS .............
LAVATORIES..........
SINKS ..............:
DISH WASHERS.......:
ELEC WTR HEATERS...:
LAUN WSHR OUTLTS...:
SPRINKLERS?......:?
HAZARD CLASS...:?
FIRE FLOW....: 0 gpm
WATER SERVICE..:FED
SEWER SERVICE..:SEP
0 sf SENSITIVE AREAS?.:?
0 URINALS......... 0
0 DRINKING FOUNT.: 0
0 SUMPS..........: 0
0 VAC BREAKERS...: 0
0 DRAINS.......... 0
0 LAWN SPRINKLERS: 0
0 OTHER FIXTURES.: 0
0
o2a-10)3-11
PERMIT NO.: 92-0824 e 5
ISSUED: 08/26/92
BY: AJ
FEES:
FINAL PLAN CHECK...* $ 265.20
BUILDING PERMIT....* $ 408.00
SBCC SURCHARGE.....* $ 4.50
MEC APPLIANCE FEES.* $ 6.50
PUB WORKS -PLAN CHECK $ 35.00
TOTAL FEES
$ 719.20
ALL 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 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.
1 V-
OWNER OR AGENT
bld_prmt 07/31/92
DATE e' ; `9 2
Pe it # r
REOSIVED
MAY 2 81992
PY .9FFEOEF#AL MAY
CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print —
CORPORATION
BOX 2 CONTRACTOR'S NAME � 6C( CONTRACTOR'S REG. # L-IVY-E-C3 /y $I Ji
q 11 Card MUST be presented
CONTRACTOR'S ADDRESS _ �Q TI+ �' CITY- - i3LA rC-JlJ , PHQNE L2
EXPIRATION DATE - 3 -
—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 �-�� ��� A.)5 � A -) PHONE' Ste- ' < <
BOX 4 SEWER DISTRICT "F -- �z WATER DISTRICT
BOX 5 ESTIMATED PROJECT COST Z &0 EXISTING BUILDING VALUATION
THE PROPERTY IS OWNED BY
SING
L I� F �-Prn� �
PARTNERSHIP
- BOX 6 PROPERTY TAX ACCOUNT NUMBERo.
LEGAL DE CRIPTION %%.M-f aov. F
A)VIZZLI3 QcC F aF a
!-SODD F
(_F - or- Nde '
F F— N 5F_ G .
ol) 5 �0.
_
(If necessary, please submit a separate page with the legal description.) I�,RA-)r_sF_- 3 G op
`- A OA P---r-'r=
K.C. Plat Recording # ? 7n p
/MLo-i 0' AN �����
GD � to
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed)
1ST FLOORW- 71 2ND FLOOR I& 7Z
3RD FLOOR / BASEMENT.
_ DECK / GARAGE J
BOX 8 � SINGLE FAMILY
NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = )
)EXISTING STRUCTURE �aG
( ) COMMERCIAL/INDUSTRIAL
TOTAL AREA OF PROPERTY
SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
MECHANICAL APPLIANCES —
BASIC FEE $
N0. 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 - &t-#tJS1Q,1J
OP $ L
DRAINS
" Wx
$
OTHER
S 6, T-r KA
$
TOTAL FIXTURES
TOTAL MECHANICAL FEE
$
I CERTIFY UNDER PENALTY OF PERJURY THATTHE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO TFl� E.N1YLEDGE
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR W41 E I'C /LI�P1I ATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY ASTO 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 RELIANCVO T� C"; iNki(I�INGITS
'FFICERS AND EMPLOYEES, QjPQA THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF PHIS APp[ ICATION.
OWNER/AGENT:
DATE: `> a0 Z----
ANP-003 3/90
I TO
�Z