03-101091 r
City of Federal Way Demolition Permit #:03 - 101091 - 00 - DE
Community Development Services
33530 lst Way S
Federal Way,WA 98003-6210
Ph:253.661.4000 Fax:253.661.4129 Inspection request line: 253.g35.30�J�
Project Name: MERRIFIELD a $���
Project Address: 30340 9TH S Parcel Number: 515365 0030
Project Description: SOFT DEMO-Clean up debris and remove wall covering as needed to access to see if there's structural
damage from water
Owner Applicant Contractor
Noble O Merrifield III &Stacy L Mercifield III MODERN BUILDERS INC MODERN BUILDERS INC
30340 9TH AVE S 3114 SO PROCTOR ST 3114 SO PROCTOR ST
FEDERAL WAY WA TACOMA WA 98409-3299 TACOMA WA 98409-3299
98003-4101 (000)383-1704
PERMIT EXPIRES September 16,2003.
Permit issued on March 20,2003
I hereby certify that the above information is conect and that ttie construction on the above described property and
the occupancy and the use will be in accordance with'the laws,rules and regulations of the State of Washington and
the City of Federal Way.
Owner or agent:�—�/\ _���� Date: ��"-'ZG'� �'�
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CONSTRUL _ JN PERMIT APPLICATIO�
CITY OF �
MAR � � 1��� PpLICATION NUMBER: � - � _ O -
FederalWay PPLICATIONNUMBER: _ _ - _ _ _ _ _ _ - _ _
CI7Y OF FEQERAL WAY
BUILDII�G DEPT PPLICATION NUMBER: - -
**The following is required information—Please pri�t(in ink)or type*' ��
Piease note: Electricai, Fire Prevention Systems and Engineering permits may require a separate application. ��`
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SITE AODRESS: �J(� "�]�V `dOC)U�.� ASSESSOR'S TAX/PARCEI #: � ��G>(C�S���
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE�ESCRIPTION IF LENGTHY): ���/I�C V I� 1��
• � • • •
TYPE OF PROJECT(This application): o BUILDING o PLlJMBING ❑ MECHANICAL�DEMOLITION
o ELECTRICAL o ENGINEERING ❑ FIRE PREVEN ON SYSTEM
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P JECT DESCRIPTION(Provide detailed description): �l�'ps-)� ( ) � � j�'� (s �}-�� �
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PROJECT NAME: ����� �����
• • • • �
PROPERTY OWNER• NAME: /r, ; DAYfIME PHON6
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MAILING ADORESS(STREET ADDRESS;CiTY,STATE,ZIP):
i � �" -�'f �?-a/�r/� � c7lJ r
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CONTRACTOR: N^ME: �_ ; DAYTIME PHON"t: ,
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i MAILING ADDRE55(STREET ADD •CIfY,STA� ZIP): I EVENING PHONE' ���e� i
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CITY OF FEDERAL WAY BUSINFSS LICENSE NUMBER: � FAX NUMBER:
��. � a�-����' I � ) =�=I��
CONTRACTORS REGISTRATION NUMBER: /� � IXPIRATION DATE:
�roPV of card required) /G./� I � /
APPLICANT' NAME: DAYTIME�HONE: �
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MAILING ADDRESS(STREET ADORESS;CITY,STATE,ZIP): ; EVENING PHONE� �
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� RELATIONSHIP TO PROJECi: I FAX NUMBER:
❑ ARCHITECT ❑TENANT ❑ OTHER(DESCRIBE): i ( � - I
j E-MAIL ADDRESS: I
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CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER p APPLICANT o CONTRACTOR �
� . : � • • •
EXISTING USE: `7�� �� EXISTING BUIIDING ASSESSED/APPRAISED VAIUATION ;
PROPOSED USE: ��� PROPOSED VAtUATION FOR IMPROVEMENTS: � �
SPRINKLERED BUILDING? ❑YES [�NO FIRE SUPPRESSION SYSTEM PROPOSED/RE
WATER SERVICE PROVIDER: �IAKEHAVEN ❑ HIGHLINE o TACOMA o PRIVATE(WELI)
SEWER SERVICE PROVIDER: �IAKEHAVEN o HIGHLINE G PRIVATE(SEPTIC)
#*NEW RESIDENTIAL OONSTRUCTION O *
NUMBER OF BEOROOMSc ESTIMATEO SEILING PRICE: �
• • • • •
OR EXISTING .FT. PROPOSED S .FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
%
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
!
TOTAL:
��' Indicate number of each type of fixture
��� MECHANICAL
�
AIR HANOLING U�itT(5) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) % FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPU►CE INSERT(S) RANGE(S) MISC.( )
COMPRES R(S) FURNACE(S)
DUCT( GAS PIPE OUTLET(S) HEAT SOURCE: p ELE C ❑ GAS
PLUNiBYtdG
BATHTUB(S) LAVATORY(S) URINAL(S) WATER H TER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑GAS
DRINIQNG FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. •
I oe�iify under peaalty of perjury tha the information furnished by me is true a�d correct to the best of my knowledge,and
further,that I am autho�ized by the owner of the above premises to perfortn the woric for which the permit application ls made. I
fu�tfier agree to hold harmless the City of Federal Way as to any daim(induding costs,expenses,and attorneys'fees incurced in the
investigation and defense of such daim),which may be made by any persory induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the dty,induding its officers and employees,upon the accuracy
of tfie I�formation supplied to tfie dty as a part of is application.
NAME/TITLE• ^ ' DATE: L��"�v ' v�
❑ PROPERTY OWNER ❑ APPLICANT �NTRACTOR
•fOROFFICE USE ONLY: ,;;
�NEW���3"ADDITION��.,.-�tl.ALTERATION��'��7uREPAIR�"��';��;�TENANT�IMPROVEMEIYT� ,,�a, .�;.`
;CENSUS;'COOE �.���� .,: ,������;�':a� .=-. '. � .� � ����-'�' .;,�=�=-� �_.�. -
'�;"� _.���'� LOT�SIZE � o--��
�ONING DESIGNATION_ �, '�•��" '�`�'., �.�, '� ' �� � '
�- �BUIL�ING.SHEL��ONLI(7�'fl YES���NO.__ - �-'
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"COMP PLAN DESIGNATION � :� �'�„�,ra�,�'t^�������BASIC-PLAN?����t3�XES„, �fl;NO�� �; ��
.�ECTION��� ,-,�TOWNSHIP_�:�" ,�RANGEX �'�S,�, .NE1N%1DDRESSRE UIRED?. .. � .a''YES.;•°e'NO >,
'�PIATTEU�LOT?�.,:❑1(ES �:o=NO ..�.�'��,��� �: CHANGE OFUSE? -�_ '�='o YES '�"-a N0
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTN•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253�61�000•FAX:253�61-4129
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