97-104183 97.Io 41 �3
Ci.:1, ,�,"� (�c-l'�F_�?f�� �,J!`Y , , ,,, PERMIT IVO. B�Z)9?-067'�
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Fecleral vJay, WR 98003 Builuing Inspection Rec�uest�; 253-���L--41�+0 BY: FC2
253-db1-40Q0 E�PIRES: Q5/16J48
�DDRESS: �16�.7 3�l�D PL SW
N0. : 12210�-�9029
F�(�0,7��1' DE�t=RIpTION-RER00fING BUILDING-T . REPLACING SHAKES WITH FIBREGLA55 SHIN6LES
-= OWNEft _________________________:_��___=___=__======__=__==-= CONTRACTQR =_==__=__=_______=_=__��_��=___==___=__=_=_=~- LENDER =_==__=______=______=__=______====_=_=___=��_���
31617T33RDLpGESwPARTMENTS � 3425MSRO��T�G INC � �
FEDERAL WAY WA 98023 i SEATTLE WA 981b8 {
� !
-8835 � 439-9491 �
� JMROOI�153l14
_�_��_____________________________________________�____._-__=�__-___---_---_---__-_________---_�_��_��_��_----_____---_--------_-__-___---_=---_____-_____-__-_______--__=___-___=d
=j= COIITRAfTORS, PLEASE USE LOCATION CODE 1732 MNEN REPORTIN6 SALES TAX FOR PROJECTS YITHIN THE CITY OF FEDERAL IiAY. TAX RATE = 8.6� #*x
- ----- --- ---- --------- ------- --- -----------
- --__��«______________________________________���_-�,�==��:�__���:��=___=___-________=_---------_------------------__ -_- -
------ ---------------------- ____-_ ____ _
- - - - --
BLD?:X MEC?:? PLM?:? FIR--EXIST--PROP--- DWELLING UNI?S: 0 � COMP PLAN.........:? � FEES: a
� TYPE OF WORK:REP USE:RES 1ST.: 0: O:sf STOR;ES........: 0 � REQUIRED PARKING..: 0 SPRINKLfRS?......:? � BUILDING PERMIT....� $ 211.50 �
� CENSUS CATEGORY.....:555 2ND.: C: O:sf HEIGHT.....: 0.00 ft � HAiARD CLASS...:? � SBCC SURCHflRGE.....� $ 4.50 �
O�CUPANCY GROUP---------- 3RD.: 0: O:s' VALURTIC4---------- � REQUIRED SETBACKS------- fIRE FLOW....: � gpm �
� •? •? •? •? • OTHR: 0: C:sf EXIST..$: 0 � fRONT.........: 0.�0 ft �
� TYPE OF CONSTRUCTION----- BSMT: 0: O:st PROP...$: 27173 SIDE..........: 0.0'J ft WATER SERUICE..:? j
:? :? :? :? . DECK: 0: O:sf REAR........... O.00:ft SEWER SERVICE..:?
OCCUPANT LOAD------------ GAR.: �: O:sf RECEIVED.:11/l7/91
. fl: 0: 0: 0: TOTL: 0: O:sf IMPERV SURFACE: 0 sf SENSITIVE AREAS?.:?
_________________�_�__.__---__-__--__-__--_��_��___�,--=-__--_--...�__._._.....�_--- __-_--_-----____-__=-_____-___--=_-________--___---
FUEL iYPES.:? ? FANS..........: 0 BOILERS/COMPRE5SORS WRTER CLOSETS.....,: 0 llRINALS,.......: 0 TOTAL FEES $ 216.00
-�- PIP;NG.; 0 ft HOOD..........: Q 0-3 TON.....: 0 BRTH TUBS..........: Q DRINKING FOUNT.: 0 �
<100K..: 0 DUCT WORK.....: 0 3-15 TON....: 0 SHOMIERS............: 0 SUMPS..........: 0 ' �
GAS NWT....: 0 WOOD STOUES...: 0 15-30 TON...: 0 LAVATORIES.........: 0 VAC BREAKERS...: 0 �
CONV BURNER: 0 �URN>100K...,.: 0 30-50 TON...: 0 ° SINKS..............: 0 DRAINS.........: 0 � {
� BBQ..,.....: 0 MISC..........: 0 50+ TON.....: 0 DISH WASNERS,......: 0 LAWN SPRINKLERS: 0 � �
� GAS DRYER..: 0 AIR NRNDLING UNITS fUEL TANKS--------- . ELEC WTR HEATERS...: 0 OTHER FIXTURES.: 0 �
RANGE......: 0 <=10,000 CFM: 0 RBOVE GROUND: 0 � LAUN NSHR OUTLTS...: 0 � �
GAS LOGS...: 0 > 10,000 CFM: 0 UNDEkGROUND.: 0 '
_----=_.y=--==-----------------�__�.____---________--__----_-__-----_-____--___-�-__----__-_--_____-____---_-----__-__-__-_______=__=�___-__==-_-_--=-___-_-__---______-__-_��
PERMITS EXPIRE 18D DAYS AFTER ISSUAlICE If NO NORK IS STARTED. RESIDENTIAL AND 6RADIM6 PERMITS EXPIRE OME YEAR AFTER DATE Of ISSURMCE.
I CERTIFY THAT TNE I�tFORMqT10N FURNISNED BY ME IS TRUE AND CORRECT TO THE BEST Of MY KNOMLED6E AIID THE APPLICABLE tITY Of FEDERAL MAY REQUIREMENTS NILL BE MET.
OWNER OR AGENT __�_.__ `�0�"'�_�_= ---------------- DATE -�`.--�� �
Ky5��239 �
FILE�dP�'
RE pMDN DE�`��`� BiJII.DINGDIVISION
� EpEI'ZAL_ COMM�N��� 33530 First Way�outh
""' Federal Way,WA 9�003
VV AY ,,�i�� '� ? ��� (253)661•;�000
Fax(253)661-4129
APPLICATION FOR BUILDING PERMIT
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PLEASE PR/NT APPLICATION# `r��"�� 1 , �
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Tenant(if known) ,� ., � .-, Lot# �i )� � Assessor's Taz#
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Buildi�g Owner's Name � �-� Address � �
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Ci � �,�f - State �',C� . Zi � �°� 7Q"`- Phone c� �' c� ��C�i;
Nature of Work � � — �� �•�.;,4•' `���.n- ' Lc."(�. /i-� �3�'�ji-'y.,l q�^-`...--� (�-�
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Name (F,M,L) � 1 � �
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Address � , �:� � � +�
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Contact Person �� � �� Day Phone � � , ��.,�; � Other Phone Fax � ������ � , �-_
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Contact Person � Phone Fax .�>c'�'�"
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Contractor's #(card must be presented) ��� �U�l * �S � e�c� Expiration Date Verified ❑ Yes ❑ No
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Name
Address
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Contact Person Phone Fax
LEGAL DESCRIPTION
P/ease Comv/ete Reverse Side
��'��;��j�� sting Use oposed Use
Parmit includes: ❑ Buildin ❑ Plumbin ❑ Mechanical �_Other
T�pe of Work: ❑ Residantial ❑ New ❑ Remodel ❑ Number of Units_ ❑ Deck
�Commercial ❑ Addition ❑ Gara e ❑ Shed ❑ Other
Enter 1 st Floor sq ft 2nd Floor sq ft 3rd Floor sq ft Existing Floor Area sq ft
Area Basement s ft Decks s ft Gara e s ft Pro osed Total Area s ft
Water Availabilit ❑ Sewer Availabiiit ❑ On-Site Se tic S stem Availabilit ❑ Pro'ect Valuation $
Zonin Lot Size Existin Bld Valuation S 2 7'��S Tx
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Name Address
Cit State Zi
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Contractor Name Address
Cit State Zi
Contact Phone Fax
License # Ex iration Date Verified ❑ Yes ❑ No
__ _.. ................................._._____......... ..................._
�'�:iJMBEItf:G �{3�1t:�"�C'T�O�#
Contractor Name Address
Cit State Zi
Contact Phone Fax
License # Ex iration Date Verified ❑ Yes ❑ No
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Water Closets Sinks Urinals Lawn S rinklers
Bathtubs Dish Washers Drinkin Fountains Other
Showers Electric Water Heaters Sum s
Lavatories Washin Machine Drains Total Fixture GounY
N NLY
E HANI AL EVALUATIO O $
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'��l�{�NICA�::�Il�t.:�`:�t1UNT.:.: :...:::::::::
Fuel T e (electric/other) Gas Dr er Air Handlin < = 10,000 CFM 15-30 Tons
Len th of Gas Pi in Ran e Air Handlin > = 10,000 CFM 30-50 Tons
Furn <t00K BTUs Gas Lo Unit Heater 50+ Tons
Furn >100 BTUs Fans Miscellaneous Fuel Tanks
Gas Hwt Hood Boilers Above Ground
Conv Burner Duct Work 0-3 Tons Under round
BBQ's Wood Stoves 3-15 To�s Total Unit Couni
DISCLAIMER: I certify under penalty of pequry that the inforn�ation furnished by me is true and correct to the best of my knowledge,and further,that I am suthorized by the owner of
the above premises to perfortn the work for which pertnit application is made.I further agree to save hazmless the City of Federal Way as to any claim(induding costs,expenses,and
attomeys'fees incutred in investigaiion 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 ofthe reliance of the city,including its officers and ecnployees,upon the accuracy of the infortnation supplied to the city as a part of this application.
Owner/Agent• _ ' ��'` � Date:�� � � ( ��/
Bunomc.Arr
flevaEo 8/28/97