23-105733City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: 286XX FDERAL WAY V1 LLC
Project Address: 28612 25TH PL S
Building - Multi Family
Permit #:23-105733-00-MF
Inspection Request Line: (253) 835-3050
Parcel Number: 5529000140
Project Description: Fire damage inspection. **No construction work approved under this permit**
Owner
Applicant
Contractor
Lender
286XX FDERAL WAY V 1 LLC
BAYLEY LEANCHOR AGENCY
CO ANCHOR AGENCY
205 LOGAN AVE S
205 LOGAN AVE S
RENTON WA 98057
RENTON WA 98057
Census Category: 434 - Residential alt/add - no change in number of units
Includes:
#1
#2
#3
#4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area (sq. ft.)
0.00
0.00
0.00
0.00
Additional Permit Information
Mechanical to be Included? ..................................... No Number of Stories................................................... 0
Is this an Online or O.T.C. application? .................. Yes Permit for Building Shell Only?.............................. No
Plumbing to beIncluded?........................................ No
No Fixtures Associated With This Permit 11
PERMIT EXPIRES Saturday, 15 June, 2024
Permit Issued on Monday, December 18, 2023
I hereby certify that the above information is correct and that the 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: F Date:
CITY OF
Federal Way
Case #
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 9'h Avenue South
PO Box 9719
Federal Way WA 98063-9718
253-835-2607;Fax 253-835-2609
www.citvoffederalway.com
INCIDENT DAMAGE CHECKLIST
Owner's Name: _ A-N ct6—WL _&16b Phone:
Date of Incident: Date of Inspection:
Site Address: 7-e(PIL ] z0&0-
Nature of Incident/Scope of Damage:
ft 1aV— 10 C &Av' ,t>t, S J-! krOk t✓t ►-� pv LIAL
(If the value of the damage is greater than 75 percent of the assessed value of the structure, a site plan is required.)
Building Posted:
NO OCCUPANCY ❑ DANGEROUS BUILDING ❑ OTHER ❑ NOT POSTED
Permits Required:
BUILDING ❑ PLUMBING CgMECHANICAL XELECTRICAL XDEMOLITION
Plans Required: XYes O No Plans to Show:
Son. P-uDr- ->vAiSS651- A-s-10 INAt$4 , F-"i t-4 (. 9>,T� 2]�-)
Engineering Required: O'Yes O No Specifically: iZt37F T1ZV55 k.5
Demolition Complete: O Yes ONo ❑ N/A 2nd Inspection Required: O Yes O No
Permit Application Information Provided to Applicant:
XDemolitian Hermit Application Fl Building Permit Application
]'Submittal Checklist TxJSSw� 2rElectrical Permit Application
O Other --
two( r �t (253) 835- -Z�&Z-)
Inspector Phone Number
"APPLICANT: PLEASE BRING THIS FORM TO THE CITY WHEN APPLYING FOR PERMITS"
RECEIVED
CITY OF
Federal Way
NOV 2 8 2023 PERMIT APPLICATION
CITY OF FEDERAL w�YPERMIT CENTER + 33325 8ti' Avenue South + Federal Way, WA 98003-6325
COMMUN[TY pEYELOgMENT 253-835-2607 + FAX 253-835-2609 + permitcenteiti4cityoffederalway.com
PERMIT NUMBER ' ,v � _ I �� ' — WF
�� L TARGET DATE
SITE ADDRESS
SUITE/UNIT #
28612 25th PI S Federal Way, WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 350,000
RM3600
552900 _ _ _ _ _ _ 0140
TYPE OF PERMIT
In BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
28612 25th PI
Damage Assessment from a fire damage.
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
286XX FW A LLC
425-470-6656
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
205 Logan Ave S
bayley@anchor.agency
CITY
STATE
ZIP
Renton
WA
98057
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
Bayley Le
206-992-8682
APPLICANT
MAILING ADDRESS
205 Logan Ave S
E-MAIL
bayley@anchor.agency
CITY
STATE ZIP
FAX
Renton
WA 98057
NAME
PRIMARY PHONE
PROJECT CONTACT
Bayley Le
206-992-8682
MAILING ADDRESS
205 Logan Ave S
E-MAIL
bayley@anchor.agency
(The individual to receive and
respond to all correspondence
CITY
STATE ZIP
FAX
concerning this application)
Renton
WA 98057
PROJECT FINANCING
NAME
286XX FW VI LLC
0 OWNER -FINANCED
When value is $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19-2Z095)
205 Logan Ave S Renton, WA 9807587
206-992-8682
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
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.
Bayley Le Digitally signed by Bayley Le 11 /21 /23
SIGNATURE: Date:2023.11 21 14:46:49-08'00' DATE
PRINT NAME: Bayley Le
Page 1 of 2
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how marty oL each tgpe o f fixture to be installed or relocated as part of this project. Do not include existin_qfLxtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (comm_sa )
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each type
o fixture to be installed or relocated as
part of this ro'ect. Do not include existingfixtures to remain.
BATHTUBS (or Tub/Show— Combo)
LAVS (Haod sioks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kicd,c„/Ub11Ly(
WATER HEATERS (ciocc,ic(
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Entrance $
EXISTING/PREVIOUS USE LOT SIZE )In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
7200 a Yes u No -i Yes L- No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
EXISTING
PROPOSED
TOTAL
... _..... �::---
"NEW HOMES ORLY"
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
S uare Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
-
TENANT AREA ONLY
PROJECT AREA ONLY
Page 2 of 2