05-100523Communiitty Development Services Building - Single Family Permit #: 05 - 100523 - 00 - SF
P.O. Box 9718 '�
Federal Way, WA 98063 -9718 v
Pb: (253) 835 -7000 Fax: (253) 835 -2609 Inspection request line: (253) 835 -3050
Project Name: EVERGREEN PARK AFH
Project Address: 32020 11TH AVE SW Parcel Number: 926493 0040
Project Description: REM - Remodel existing garage to create habitable space for use as (3) additional bedrooms in adult
family home. Includes mechanical for ductwork.
Owner
Applicant
Contractor
Lender
MARIJANA DUMINICA
EVERGREEN PARK * MARIJANA D
EVERGREEN PARK * MARIJANA D
NONE
3310 178TH AVE NE
32020 11TH AVE SW
REDMOND WA 98052
FEDERAL WAY WA 98023
32020 11TH AVE SW
FEDERAL WAY WA 98023
NONE
Includes:
Census category: 434 - Reside
#�
#2�
#3 f g #4
L
Occupancy Group:
j Construction T
R -3
Type V - N
r Occupancy laa
Floor
y .. ivawrr.
i.�yi
Census C9, ry .....I„. �s ..... .........................
...................... 434 - Resideat al alt/a44, *not Mechanical ....,, . .... ...., �'esr
Occu auc #1...,.. ..,................... I........ ...i ....... NO
p yGtrp .... .........................R *3 ' . .Plumbirt�
Description Qua� nti l , Descri tion Des _ -]Q�uan_ti,
!Ducts — = - - -- - - -- —_�
I hereby certify that the above inf,
the occupancy and the use will be
the City of Federal Way.
Owner or agent:
PERMIT EXPIRES August 3, 2005.
Permit issued on February 4, 2005
iation is correct and that the construction on the above described property and
accordance with the laws, rules and regulations of the State of Washington and
Date: ' - lb� 46�5- -
1weaA
DATE INSPECTOR AREA • ' TYPE %-,t'INSPECTION
i
' - THIS CARD IS TO MAIN ON SITU
CITY OPfommunity Develo m t Inspection Record
P P
Federal Way IVR INSPECTM: .REQUEST PHONE # (253) 835 -3050
PERMIT #: 05- 100523 -00 -SF
Owner: MARIJANA DOMINICA
Address: 32020 11TH AVE SW
FEDERAL WAY, WA 98023 -5548
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on -site. DO NOT LOSE THIS 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.
❑ Temp. Erosion Control (4365) ❑ Plumbing Groundwork (4190) ❑ Underfloor Framing (4285)
To be done prior to breaking ground Approved to cover Approved to sheath floor
By Date By Date By v/ Date
Floor Sheathing (4105)
❑
Shear Walls (4245)
❑
Roof Sheathing (4220)
Approved to install flooring
Approved to install siding
Approved to install roofing
By Date
By
Date 3' 2 —or
By
Date
❑ Mechanical Rough -in (4165)
❑
Gas Piping (4125)
❑
Fire/Draft Stops (4095)
Approved
Approved to release test
Approved
B Date
By
Date
By
14? Date
NOTE: Prior to scheduling a Framing (4120)
❑
Framing (4120)
❑
Insulation (4150)
inspection; Electrical, Plumbing & Mechanical
Approved to insulate
Approved to install wallboard
Rough -in and Fire/Draft Stop inspections must be
signed -off and approved. IBC 109.3.4/UBC 108.5.4
By
Date 3'''
By �� Date
❑ Gypsum Wallboard Nailing (4130)
❑
Final - SWM (4375)
❑
Final - Mechanical (4065)
Approved to install mud & tape
Approved
Approved
B Date -_
By
Date
By
Date
❑ Final - Building (4050)
❑Temp. Erosion Maintenance (4370)
Approved
Approved
By Date
By
Date
arr of A
Federal Way
COMMUNITY DEVELOPMENT SERVICES
33325 JIB AVENUE SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063.9718
253 -835 -2607• FAX 253 -835 -2609
www. cittioffederalway. com
The following is
SITE ADDRESS
PERMIT
APPLICATION
- an incomplete application will not be
rs��r
SF MF CO ME EL PL DE EN FP
0
!pted. Please print legiblu fin inkJ or tune.
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # C? 6�- 6 -�( -!� -'.y- `6 O IT LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
)Attach separate page far k gfhg legal description)
PROJECT • •
TYPE OF PERMIT >( BUILDING ❑ PLUMBING ^MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
vl / I*, e1z l/ 11 /�tz
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY PHONE 47
MAILING ADDRESS 77/' CITY, STATE, ZIP
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILINC4DDRESS
CITY, STATE, ZIP -
CELL PHONE
(
MAILING ADDRESS
CITY, ATE, ZIP e�
tfiLtGC C )" ciJ
CELL PHONE -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
/ /
(
— — — — — — — — — --B L
CONTRACTORS REGISTRATION NUMBER (eopy of cud required with each application) EXPIRATION DATE
COMPANY NAME (��/^ Y�I I K,
/ix ilY /c -
APPLICANT NAME r <
yl/ /c�/9 r�
OFFICE PHONE
Ofgo ,'a o- lZ �3
MAILINC4DDRESS
CITY, STATE, ZIP -
CELL PHONE
(
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
( -
NAME PHO�J - � E -MAIL ADDRESS
O fidei q trtallo" NAME
MAILING ADDRESS CITY. STATE, ZIP
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE 3°20 two VALUE OF PROPOSED WORK $ xp200
SPRINKLERED BUILDING? ❑ YES ifNO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES d-NO
WATER SERVICE PROVIDER +(LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER VLAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION - I EXISTING G PROPOSED FT. SO. FT. I + O FT
FIRST /0"OO/l�3
SECOND/
FLOORS
I
DECK (COVERED?)
RED ?)
GI ARAGE 19 CARPORT ❑
PROPOSED
NUMBER OF FLOORS TOTAL
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
HECCFiAHICAL e�
Value of Mechanical Work $ K �d
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLVJWING
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAYS (Bathroom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (Commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS goiietl _-
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 the permit application is made. 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 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. �,� %
NAME/TITLE Af, ?i lt / /1t I¢— C� 1 / 1���' u DATE
ignature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin # 10o —January 7, 2005 Page 2 of 4 k\Handouts\Permit Application