92-101678 - ' - �' 91� ib 1 �78
CITY OF FEDERAL WAY B U I L D I IV G P E R M I T PERMIT NO.: BLD92-2249
3;i530 Firs: Way South BUILDING INSPECTION - 661-4140 ISSUED: 11/19/92
F=ederal Way, WA 98003 BY: FLF
U61-4000
SITE ADQRESS: 417 S 289TH S'1°
PARCEL NO.: 515298-0170
PROJECT GESCRIPTION: RITCHEN REMODEL, BREARFAST PTOOR & HOBBSt ROOAi ADDITION. DeCk is �o� permi��ed Wi�h �his p
ONNER CONTRACTOR LENDER
MIKE MIZUMOTO SAMDAL CONSTR INTRR/MLLNRK CO
417 SO 289TH ST. 8217 E 176TH ST
FEDERAL 41AY WA 98003 PUYALLUP NA 98373
4599
SAMDACI108N0
BLD?:X MEC?: PLM?: FLR--EXIST--PROP--- DWELLING UNITS: 1 COMP PLAN.........:SR FEES:
TYPE OF UORK:ADD USE:RES 1ST.: 0: 100:sf STORIES........: 2 REQUIRED PARKING..: 2 SPRINKLERS?......:? FINAL PLAN CHECK...* S 105.30
CENSUS CATEGORY.....:434 2ND.: 0: O:sf HEIGHT.....: 0.00 ft HA2ARD CLASS...:? BUILDING PERMIT....* $ 162.00
OCCUPANCY GROUP---------- 3R0.: 0: O:sf VALUATION---------- REOUIRED SETBACKS------- fIRE FLOW....: 0 gpm SBCC SURCHARGE.....* S 4.50
:R3 :? :? :? : OTHR: 0: O:sf EXIST..S: 0 FRONT.........: 20.00 ft FINAL PLAN CHECK...* $ 30.00
TYPE OF CONSTRUCTION----- BSMT: 0: 104:sf PROP...$: 14969 S1DE..........: 5.00 ft WATER SERVICE..:FEO
:5N :? :? :? . DECK: 0: O:sf REAR........... 80.00:ft SEWER SERVICE..:FEO
OCCUPANT LOAD------------ GAR.: 0: O:sf RECEIVED.:10/02/92
. 0: 0: 0: 0: TOTL: 0: 204:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:Y
FUEL TYPES.:? ? FANS..........: 0 BOILERS/COMPRESSORS LJATER CLOSETS......: 0 URINALS........: 0 TOTAL FEES S 301.80
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: 0
GAS DRYER..: 0 AIR HANDLING UNITS FUEL TANKS--------- ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0
R""r�.....,; 0 <=10�000 CFM: O ABOVE GROUND: O LAUN LJSHR OUTLTS...: O
[ OGS...: 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.
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.
; � �._C,
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CITY OF FEDERAL WAY
BUILDING PERMIT APPLICATION
— Please Print—
BOX 1 �TENANT NAME:
OWNER � v� SITE LOCATIO LK'�
JWNER'S ADDRE S 7 CITY Ol PH NE •
'� DESCRIBE JOB Y,e� _
THE PROPERTY IS OWNED BY:�/MAR IED OGUi�GYG� GCpARTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME CONTRACTOR'S REG. #
'����� Card MUST be pre,sented
CONTRACTOR'S ADDRESS CITY PHONE_ �'���
EXPIRATION DATE
— OR—
I HAVE READ CHAPTER 18.27.010 RELATING TO DEFINITIONS OF GENERAL CONTRACTORS AND SPECI CON ACTORS AND
CHAPTER 18.27.1101NHICH PROHIBITS ISSUING PERMITS W�THOUT PROOF OF REGISTRATION. '
BOX 3 CONTACT PERSON D GG PHON �� �3�� I�CS
BOX 4 SEWER DISTRICT WATER DISTRICT j'llCt �-
BOX 5 ESTIMATED PROJECT COST lO � —' l'JD40 EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NtJMBER �` 5�52��'O/70 'QZ
LEGAL DESCRIPTION ��' �'�+�' i'� /"�,!,:�_ i � ,�� �s� , , .� ; � , ;1
(If necessary, piease submit a separate page with the legal description.) -
K.C. Plat Recording#
BOX 7 BUILDING SQUARE FOOTAGE: �Proposed) 1ST� F 00 �� 2ND FLOOR / - -
3RD FLOOR J BASEMENT / O �DECfL_� GARAGE /
BOX 8 (vr"SINGLE FAMILY ( ) W CONSTRUCTION
( ) MULTIFAMILY(N0. OF UNITS = ) ( EXISTING STRUCTURE __. _ _ _ _
( ) COMMERCIAVINDUSTRIAL TOTAL AREA OF PROPERTY SQ� .
BOX 9 PLUMBING FIXTURES (including rough-ins) � � -�� � MECHANICAL APPLIANCES— BASIC FEE��----- �
N0. WATERCLOSETS GAS PIPING, FEET . �.___ . _ .
-
BATHTUBS N0. FURNACE, ELEC. GAS $
SHOWERS
GAS HOT WATER HEATER- � � "— $�---� �-
LAVATORIES - - - CONVERS�tON BURNER - -- _ _ ___ �_ _
SINKS BOILER, SIZE BTU $
DISHWASHERS - -- - IR HANDLING UNITS -'
�.----- __
ELECTRIC HOT WATER HEATER - -�EAT 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
�ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THF ABOVE PREMISES TO PERFORM THE WORK FOR WHICN PERMIT APPLICATION IS
",4ADE.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 CIAIM), WHICH MAY BE MADE BY ANY PERSON, INCLUDING THE UNDERSIGNED,
4ND FILED AG,�INST THE CITY OF FEDERAL WAY, BUT ONLY WNERE SUCH CLAIM ARISES OUT OF THE RELIANCE OF TNE CITY, INCLUDING ITS
�JFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLfED TO THE CITY AS A PART OF THIS APPLICATION.
/
JWNER/AGENT: �ATE:' 2 � ���2
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