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THIS CARD IS TO `�EMAIN ON -SITE
CITY OF Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 04-104011-00-MF
Owner: PATRICIA ING
Address: 27912 PACIFIC HWY S
FEDERAL WAY, WA 98003-3084
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE TIi1S CARD.
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work must not
be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On -going inspections
are logged on the back of this card.
❑ Footings/Setback (4110) ❑ Foundation Wall (4115) ❑ Drainage/Downspout (4040)
Approved to place concrete Approved to place concrete Approved to backfill
By Date By Date By Date
❑ Re -steel (4215)
Approved to place concrete or grout
By Date By
❑ Underfloor Framing (4285) ❑
Approved to sheath floor
By Date LBy
Roof Sheathing (4220)
Approved to install roofing
By Date By
❑ Gas Piping (4125) ❑
Approved to release test
By Date By
Plumbing Groundwork (4190)
Approved to cover
ht J Date
�I-
i
Floor Sheathing (4105)
Approved to install flooring
Date
Rough Plumbing (4230)
Approved
Date
Fire/Draft Stops (4095)
Approved
Date
❑ Slab/Concrete Floor (4255)
Approved to place concrete
By Date
❑ Shear Walls (4245)
Approved to install siding
By Date
❑ Mechanical Rough -in (4165)
Approved
By Date
NOTE: Prior to scheduling a Framing (4120)
inspection; Electrical, Plumbing & Mechanical
Rough -in and Fire/Draft Stop inspections must be
signed -off and approved. IBC 109.3.4/UBC 108.5.4
❑
Framing (4120)
❑
Insulation (4150)
❑ Gypsum Wallboard Nailing (4130)
Approved to insulate
Approved to install wallboard
Approved to install mud & tape
By
Date
By
Date
By
Date
❑
❑
Final - Fire Department (4060)
❑
Suspended Ceiling Grid (4265)
Final - Planning (4070)
Approved to drop tile
Approved
Approved
By
Date
By
Date
By
Date
❑
❑
❑
Final - Public Works (4080)
Final - Mechanical (4065)
Final - Plumbing (4075)
Approved
Approved
Approved
By
Date
By
Date
By
Date
M Final - Building (4050)
Approved
B Date
00AfMUN17Y DEVELOPMW SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
Cc"cof � �- REC E l M b ! FEDERAL WAY, WA 9800-9718
Federal way I RMIT APPLICATI G ' '1.; 5• ,�1m'z'
r.r oe- u.. oaf FW File Number: - 1 - L TO"
C.GIYu
UITE/APT #
ASSESSOR'S TAX/PARCEL #: Z Z O eL 8 Q - (n Z L O SQUARE FOOTAGE OF LOT: 1, 6 z`i S. F, �J
LEGAL DESCRIPTION (e.g.: Anne Estates, Lot 1)
(Attach separate page for lengthy legal description)
TYPE OF PERMIT (This application): �UILDING �IIMBINQ MECHANICAL (� DEMOLITION
ECTRICAL G�ERraG PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onluh. C'o11���>- �� � S A)c, j,6sU j.[D',�RY�
-C
PROJECT • -
•7a %A
,' ` ■ PEOPLE INFOR51ATION
PROPERTY
OWNER:
CONTRACTOR
LENDER
PfP—r- .d v.d. a $5.0001
APPLICANT:
NAME: PRIMARY PHONE:
I (ZC4, )ZYI - 1a98
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
pri 433AILfa
NAME I
COMPANY
OFFICE PHONE:
�d aio
-
(0,CG) zyi -tea
MAILING ADDRESS ISTREET ADDRESS;): <.L G
CriT, STATE, Z[P
CELL PHONE:
CtTY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
EXPIRATION DATE:
FAX NUMBER -
CONTRACTORS REGISTRATION NUMBER
EXPIRATION DATE:
(copy of eard regahvd with each appliutlenl _ _
/
NAME: DAYTIME PHONE:
( 1 -
MAIWNG ADDRESS (STREET ADDRESS;): CrfY, SPATE, ZIP
NAME:
COMPANY
OFFICE PHONE:
( 1
MAILING ADDRESS ISTREET ADDRESS):
CITY. STATE, ZIP
EVENING PHONE:
( 1
RELATIONSHIP TO PROJECT:
0 Architect ❑ Tenant ❑ Other (Descrber
FAX NUMBER-
( 1 -
CONTACT PERSON FOR THIS PROJECT. ❑ Property Owner ❑ Contractor V Applicant E MMLADDRESS.
DETAILED BUILDING INFORMATION
EXISTING USE: ea C7i— L a. PROPOSED USE: !Sll+ of o,ryrt7�rce.T7�iJ
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORN: $ ;rL,)
SPRINKLERED BUILDING? ❑ YES K NO FIRE 'SUPPRESSION SYSTEM PROPOSED/REQUnUM?: ❑ YES R( NO
WATER SERVICE PROVIDER! ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGBLINE ❑ PRIVATE (SEPTIC)
pRE1l DE
I3f+SE�~�
FIRST
SECOND
THIRD
i
ki DITIONAL FLOORS (DESCRIBE)
DECK (COVERED?)
HOW MANY FLOORS?
HOMES ONLY- NUMBER OF BEDROOMS
FT. I PR
TOTAL r]OSTDfG SOTAL PROPOSED
ESTIMATED SELLING PRICE $
FT. 1 TOTAL
TOTAL EMSTMG AND PROPOSED
indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain
MECHANICAL 4�
Value of Mechanical Work $
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
WO ODSTOVES
BBQS
_ FANS
HOODS (cumin ,6.11
RANGES
MISC (DescriUDescej
BOILERS
FIREPLACE INSERTS
GAS WATER HEATERS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
SHOWERS
WATER CLOSETS (rou-4
MISC (Describe)
BATHTUBS tar Tub/Sho rCa bol
�`
IDRINIaNG FOUNTAINS
DISHWASHERS
SINKS
RAINWATER SYST
GAS PIPE OUTLETS
SUMPS
HOSE BIBBS
WASHING MACHINES
URINALS
ELECTRIC WATER HEATERS
LAVS tj m si..fa
VACUUM BREAKERS
I.eert(& 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 the permit application is made. I further agree to -hold
harmless the City of Federal P74xvas any cl irn (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such ctaiaq, which may be made y perso , I Iud' the undersigned, and f led against the City of Federal Way, but only where such claim
arises out of the reliance ojth netudire is ojfec sand employees, u accuracy of the information supplied to the city as a part of
this application. �% ?
. DATL•' +' �c� Q
NAME/TITLE (11*1
mat I
RELATIONSHIP P ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
F,ORaFFiCE,[7$E�NI$Y ,. - r"`
a X.`W a ADDITION a ALTERATION a REPAIR T>11
BUiLDINQ SHELL ONLY? a YES is NO BASIC PLAN?..
ZONING DESIGNATION' C•CxE OF t7S
NEW ADDRESS REQUIRED? o TES - n NO UP/SEPA/SU?.
PLATTED LOT? a YES a NO DEbIO PERbUT
f
Butletin Il 100 — March 30, 2004 1 Page 2 of 4
IMPROVEMENT
a YES
ONO
a YES
ONO
o-YES
a NO
riRED? a YES
a NO
MRandouts — ReviseMelmit Application
23
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27912 PACIFIC HWY S Phone: 839-8222 M
T Apartments Units: 222 0 I50 —100 Feet Q G
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Kroll Page: 366 Patrol District: FW3 Tile: 5 Scale: 1 inch =109 feet •'