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Per "t #
RECEIVED CITY OF FEDERAL WAY
MAY 0 3 1991 BUILDING PERMIT APPLICATION
OfTy OF BUILDING veoiaDEPT. AY —Please Print —
BOX-1 TENANT NAME:
OWNER I I i n" 1 ii r, SITE LOCATION S 0 Ce 2 d lrv{ 3 Iti J C2,
OWNER'S ADDRESS CITYPHONE Z?9
DESCRIBE JOB , I A X
THE PROPERTY IS OWNED BY: SINGLE/M�B$!ED RTNERSHIP CORPORATION
BOX 2 CONTRACTOR'S NAME • rt A CONTRACTOR'S REG. # 0 U 0
Card MUST be presented
CONTRACTOR'S ADDRESSC701 Ct, CITY OVQG+ PHONE, _
EXPIRATION DATE
—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.
I�L1�1�
BOX 5 ESTIMATED PROJECT COST EXISTING BUILDING VALUATION
BOX 6 PROPERTY TAX ACCOUNT NUM
LEGAL DESCRIPTION _ .- n'+
(If necessary, please submit a separate page with the legal description.)
K.C. Plat Recording #
BOX 7 BUILDING SQUARE FOOTAGE: (Existing/Proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / BASEMENT-1— DECK / GARAGEJSf
f
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY (NO. OF UNITS = } ( ) EXISTING STRUCTURE
( ) COMMERCIAUINDUSTRIAL TOTAL AREA OF PROPERTY SO FT
BOX 9 PLUMBING FIXTURES (including rough -ins)
N0. _WATERCLOSETS
BATHTUBS
TORIES
ELE TR HOT WATER HEATER
LAUN Y WASHER OUTLET
INKINkFOUNTAINS
MPS, SP INKLER VACUUM BREAKERS
OTHER
TOTAL FIXTURES
MECHANICAL APPLIANCES —
ASIC FEE $
GAS PIPING, FEE
$
NO.. FURN E, ELEC. AS
$
GAS H07\WATER HEA
$
CONVERSION BUR
$
BOILER, SIZE BTU
$
AIR HANDLI UNITS
kE
$
HEAT PU S,
$
UNIT ATERS
$
AIR DOLING UNITS, E
$
MERCIAL HOOD
$
OTHER
$
$
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
AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PERFORM THE WORK FOR WHICH PERMIT APPLICATION IS
MADE. I FURTHER AGREE TO SAVE HARMLESS THE CITY OF FEDERAL WAY AS TO ANY CLAIM (INCLUDING COSTS, E?(PE SE$, 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 RELIANCE OF THE CITY, INCLUDING ITS
OFFICERS AND EMPLOYEES, UPON THE ACCURACY OF THE INFORMATION SUPPLIED TO THE CITY AS A PART OF THIS APPLICATION.
T ul
OWNER/AGENT: ` �� DATE:
ANP-DOB 3/90
OFFICE USE ONLY (PLEASE DO NOT WRITE BELOW ,'HIS LINE) a;
ZON 5 Z. z- SETBACKS: FRONT SIDE. 5 ' - REAR HEIGHT LIMIT G r
PLANNING DEPARTMENT APPROVAL]
REMARKS: ���rs�� ��,zrE.�/
1 orz sty, o a�rr�.a T,m�r dF ��Qv�2�a �/w su.eF.+ �� .ram r��•a t s�.s�r�rr�� �� i��;t7�ly>:;'� ?'.i�r
Ae %l�cow�
SEPA: EXEMPT v NOT EXEMPT [_ �'r�,s r•� n b�, Gon �br,,
FIRE DEPARTMENT APPROVAL
REMARKS:
PUBLIC WORKS DEPARTMENT APPROVAL DATE
REMARKS:. Z�I L 1�T2.4/ SY Si E �n SrL C .aE �O^./S%� /OL�.•P
TYPE OF JOB: NEW RESIDENCE RES, ADD/ALTO NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ADD/ALT NEW MULTIFAMILY (UNITS y
MULTIFAMILY ADD/ALT TENANT IMP. OTHER
OCCUPANCY - _ M TYPE OF CONSTRUCTION AJ STORES
L Q BUILDING SQ. FT. @ 70 -2,1 2
_ BUILDING SQ. FT. @
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SO. FT. TOTAL VALUATION Cl
BUILDING DEPARTMENT REMARKS:
RECEIVED
MAY 0 3 1991
ASSIGNED ADDRESS:
Amount
PARTIAL PLAN CHECK FEE RECEIVED
Date
PERMIT FEE
10
PLAN CHECK FEE
PLUMBING FEE
MECHANICAL FEE
TOTAL BLDG. FEES
PART P/C FEE
SEPA REVIEW
S.B.C.C. FEE
`�' 1
OTHER FEES
AMOUNT DUE
Receipt #
/^� / BUILDING DEPARTMENT APPROVAL
BY — DATE !.�) - 1 �, - (- —
ACCEPTED FOR FILING
N
SEATTLE-KING COlI M DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH SERVICES
Total Fast $75.00
APPLICATION FOR HEALTH DEPARTMENT
APPROVAL OF BUILDING PERMIT
Submit application, route map, building permit plot plans, and other required documents in triplicate.
The following must be completed and the fee must accompany this application:
Note: If the property is located In unincorporated King County, make direct application to the King
County Building and Land Development Division (B.A.L.D.). Properties in incorporated cities apply
to local building departments.
PROPERTY INFORMATION
F7 House/structure is served by an on -site sewage (septic) system
Distance to the nearest public sewer
Address of property G : S �C d eva�
--a-
Parcel Number (Tax Lot Account #) Q 7 'L 'Z 0 3 L t
Appl icant's name Ly�Lc & f L TiJ _6V t, Lam•
Applicant's mailing address 0
Owner's name Lf1p" _7 r l Y e7
s r•
I Phone ld
: � Ll
Day Phone
Age of house Number of existing bedrooms Existing square footage of house.
Are additional bedrooms being constructed or created?
Description of proposed chn as/remodeling (attach plot plans, showing existing structure, remodeling
and septic system) : ice- odc/1 d�/ ` �a � �� - Cam` � V
New square footage after construction
SEK4M SYSTE14 INFORMATIONi
Approximate dates septic tank was pumped (attached receipts)
Additions or major landscape changes since house was constructed (examples: add famil room, bed-
rooms, garage, patio, deck, pool, etc.; major fills or excavations done in landscaping :
Additions or repairs to sewage system (give date and describe briefly)
Other information which would be helpful in evaluating the sewage system (le. drainfield easements,
covenants, etc.):
WATER SUPPLY TWORMATION
r__J Public system (2 or more connections) [] Private (well, spring, etc.)
Attach copies of well log, well
Name of Public Supply covenants, chemical/bacteriological
sample reports
FOR HEALTH DEPARTMENT USE ONLY
APPROVED 3 BY:
DISAPPROVED Date BY:
Date
• .� .7 d n : r •
Comments�/Conditions:_,(Z
WJ Ao
OCT 14 1991
CrrV Of- VEUEW14L WAY
BUIIDMIO MR
Any person aggrieved by any decision or 'Final order of the Health Officer may make written application for
appeal to the King County Board of Sewage Review if done so within 60 days of the above decision.
/hd/sewage/forms/form37/6-3 91
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OCT 4 1991