93-101150 ,- � g� -�o���v
�„TY OF FEDERAL WAY �U i L D I N G PE R M I T' PERMIT NO.: BYaD93�0497
�3�30 First Way South BUILDING INSPECTION - 661-4140 ISSUED: 06/25/93
�ed�eral Way, WA 98003 ��� BY: FLF
�6'.-4000
SEi:� ADDRESS: 28220 28'I'H P�i1E S
PARCEL NO.: 111700-0190
I�ROJECT DESCRIPTION: 1tESIDENTIAY, 1�DD�TION — G ` �XT IODJ D TO XYS'I'ING GARAGEo `.
OWNER TRACT LENDER
DOROTHY LEWIS E S1DE P NSLTS H PRMT
28220 - 28TH AVE S 23 CHERO BLVD �,
°FDcP.AL k'AY WA 98003 PUY ` UP W
9-9121 848-8539
� EASTSIC0�8L5
8LD?:X MEC?: PLM?: PL IST--PRO -� D LING UNITS: 0 COMP PLAN.........:SR ;, : FEES:
TYPE Of WORK:ADD USE:RES .: 0: O:sf S........: 1 REQUIRED PARKING..: 2 SPRINKLERS?....� PLAN CHECK DEPOSIT.* S 70.20
CENSUS CATEGORY.....:438 ND.: 0: O:sf HEI T.....:--0_00 ft IrAZAR LASS..,: PUB WKS PLCK(SF)..93 S 40.00
OCCUPANCY GROUP---------- 3RD.: 0: O:sf VALUATION--- - R UIRED SETBACKS------- FIRE FL ....: gpm FINAL PLAN CHECK...°' S 0.00
:M1 :? :? :? : OTHR: : O:sf EXIST..S. 0 NT.........: 20.00 '�' BUILDING PERMIT....* $ 108.00
� TYPE OF CONSTRUCTION----- SMT• : O:sf PROP...S: f .........: 5 t SE CE.,:FED SBCC SURCHARGE....."' S 4.50.
:5N :? :? :? : . 0: O:sf REAR . .......: . t S R SER E..:FED
IOCCUPANT LOAD------------ GAR.: 0: k80:sf RECEIVED.:OS 2/93
. 0: 0: 0: 0: TOTL: 0: 680:sf IMPERV S FAC 0 SENS IVE AREAS?.:N
I FUEL TYPES.: FANS..........: 0 BOILERS/COMPRESSORS WATER C SE ..... 0 URINALS........: 0 T FEES S 2�2e70
GAS PIPING.: 0 ft HOOD..........: 0 0-3 HP......: 0 BATH TUBS.......... 0 DRINKING FOUNT.:
fURN<1�OK... 0 DUCT 410RK...... 0 3-15 HP...... 0 SHOWER .......... SUMPS...........
GAS HWT..... 0 NOOD STOVES.... 0 15-30 HP..... 0 LAVATOR ......... VAC BREAKERS....
CONV BURNER: 0 FURN>100K.....: 0 30-50 HP....: 0 NKS.... .........: 0 DRAINS.... ....: 0
BBa........: 0 MISC..........: 0 5+ HP....... D NASH ......: 0 LANN SPR S: �
""' DRYER..: 0 AIR HANDLING UNITS FUEL TANKS---- --` � ELE' TR HE RS...: 0 OTHER F TUR
�......: 0 <=10,000 CFM: 0 ABO E GROU 0 ` LAUN HR OUTLTS...: 0
LOGS...: 0 > 10,000 CFM: 0 UND GROUND. 0
LYLL PERMITS EXPIRE 180 DAYS AFTER ISSU4NC F NO WORK IS STAR RE DENTIAL 61ND GRADING PERMITS P NE YEAR.4 DA O SSUANCE.
1•(CERTIFY THAT THE INFORMATION FURNISHED � E IS TRUE AND C�T TO THE BEST OF MY KNOWLEDGE AND HE PPLICABLE C.I OF F AL WAY REQUIREMENTS WILL BE MET.
(y��.
�'WNER OR AGENT DATE � � � � . C� ?
kxlld_prmt 10/23/92 \
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w��� City of Federal Way �
-�— �--:--•�rr�
�� � PPLICATION FOR BUILDING PERMIT
�i���IVE� �
MAY 12 1993
PLEASE PR/NT ��AI,.WAY � t� *.'_V y� APPL/CA T/ON #:_�v�� _ C `r ��
X STTE LOCATION Add�ess � � 2 z- � �Z � N�% � S r�`; a L� -
Tenant (if known) Lot# Assessor's Tax #
' c� � ' � . ` S /!� c�C:i 'U /`�U
Building Owner Name Address
z z Z b Z � NV l u� !� � �
City •� � � � State �G Zip Phone � 3 cj� �C� Z /
Nature of Work � _ � � _ _
��GG�'7"r"� t 6�tt"�-��- [.+�.u-CCLe� � .�'�-� Qc�ti'�j�
� � �
� APPLICANT
Name (F,M,l)
.� C i�c. „ ;.s., r�-� _. .�A �
Address
-. o > , 1v -\
c�ty :, '' ll� stece �` z�P �1� �> y
Contact Person Day Phone Other Phone Fax
.J"""�' f //1�� � �/ �� �� '
Eo���_
�t�<tc
� BUII,DING CONTRACTOR ' �
Company Name
f H-�
Address •
City State Zip
Contact Person Phone Fax
Contractor's # (card must be presented) Expiration Date Verified ❑ Yes ❑ No
k ARCHTTECT
Name
� U l,
Address
City State Zip
Contact Person Phone Fax
�( LEGAL DESCRIPTION ���. ,��. �
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Please Coma/ete Reverse Side
CD0492 IRev 4/931
�UCTURE .i :isting Usa 'roposed Use � �` ,-�
� r'���c �+.
ermit includes: Building O Plumbing O Mechanical ❑ Other
Type of Work: ❑ Residential ❑ New ❑ Remodel � Number of Units ❑ Deck
� ❑ Commercial ❑ Addition Garage ❑ Shed ❑ Other
Enter 1 st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement sq ft Decks sq ft K Garage '`/�� sq ft Proposed Total Area sq ft
Water Availability Sewer Availability On-Site Septic System Availability ❑ �. Projecf'Valuatio� $ ;,�'1;� � �'
Zoning �' �� i', ) Lot Size �� ��'� " f . �- � "�(Existing Bldg Va�uation 5
LENDER /�-
Name Address
City State Zip
_ __ _ _ _ _____
_ _ _ __ _ _ _.. ___ __ _
___ _ __ . _..__ ... __... _ _ _. _
_ _ _ __ _. __ _....... ..__ _ __....... ...
MECHANICAI.;:CONTRACTOR �
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
_. __ . ..___.... ......._..........._ . __.__
_ .._.............................._........._.........._...................
_..............................................................................._
_.........
P.LUMBING GONTRA:CTOR: ,�
Contractor Name Address
City State Zip
Contact Phone Fax
License # Expiration Date Verified ❑ Yes ❑ No
PLUMBING FIXTURE COUNT ,�,
Water Closets Sinks Urinals Lawn Sprinklers
Bathtubs Dish Washers Drinking Fountains Other
Showers Electric Water Heaters Sumps
Lavatories Washi�g Machine Drains Total'Fixture Coun[
MECH�NICAI: UNIT'COU1V'I�` �
Fuel Type (electric/other) Gas Dryer Air Handling < = 10,000 CFM 15-30 Tons
Length of Gas Piping Range Air Handling > = 10,000 CFM 30-50 Tons
Furn <100K BTUs Gas Log Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Conv Burner Duct Work 0-3 Tons Underground
BBQ's Wood Stoves 3-15 Tons 7otal,Unit Caunt
DISCLAIMER: I certity under penalty of perjury thet the information fumished by me ie true and conect to the best of my knowledge end further thet I am authorized by the owner
of the above premises to perform the work for which permk applicetion ie made,1 further apree to save harmlese the City of Federal Way ae to any claim(includina coste,expenses,
and attomeys'fees incurred in investigatian and defense of such claim►,which may be made by any person,including the undersigned,and filed egainst the City of Federal Way,
but anly where such claim arises out of the reliance of the City, including its officers and employees,upon the accuracy of the information suppliad ta the City as a part of this
application.
\�Owner/Agent: / � %`�� Date: � � �� � 7 �
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