05-1047000
City of Federal Way Demolition Permit #: 05 - 104700 - 00 - DE
Community Development Services
P.O. Box 9718
Federal Way, WA 98063 -9718
Ph: (253) 835 -7000 Fax: (253) 835 -2609 Inspection request line: (253) 835 -3050
Project Name: HENDRICKSON
Project Address: 224 SW 301ST Parcel Number: 233730 0380
Project Description: Complete demo of existing home
Owner
Applicant
Contractor
Daniel R Hendrickson & Carolyn J Hendricksot
WM DICKSON CO
WM DICKSON CO
224 SW 301ST ST
3315 S PINE ST
3315 S PINE ST
FEDERAL WAY WA
98023 -3934
\TACOMA WA 98409
(253) 472 -4489
PERMIT EXPIRES September 14, 2007.
Permit issued on September 14, 2005
I hereby cer't4 that the above information is correct and that the construction on the above described property and
the occupancy and the use will be in accorda, with the laws, rules and regulations of the State of Washington and
the City ,o 1 Way. �. ,
• THIS CARD IS TO 40MAIN ON -SITE
C,TYOP Community Development Inspection Record
Federal Way IVR INSPECTIONN REQUEST PHONE # (253) 835 -3050
PERMIT #: 05- 104700 -00 -DE
Owner: DANIEL R HENDRICKSON
Address: 224 SW 301 ST ST
FEDERAL WAY, WA 98023 -3934
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.
❑ Final - Building (4050)
Approved
By Date !D s • &Ai
C" of A 0
Federal Way RECEIVED PERMIT
COMMUNITY DEVELOPMENT SERVICES
333253-835-2607-,FAX AY, A9 P3,9DO9'BEP 1,4 20APPLICATION
FEDERAL WAY, WA 98063 -WX
www.dtwffedera—lwu.com
CITY OF FEDERAL WAY
The following is reytg�l r�I{t(n(t - an incomplete
SITE ADDRESS j�),f rl 7 J W
ASSESSOR'S TAX /PARCEL # O2- j 3
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
S
1vi5ro
-40a -7-0-�O
SF MF CO ME EL PL DE EN FP
D / /
wtil not be accepted. Please
= 0__ - 6— LL iL
(Attach separate page jor l-Wft hgal d— *,ft —j
■ PROJECT INFORMATION
SUI'
to tnf or
N
LOT SIZE (sf)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
2DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed de cription of work included on this Permit onlul
Z I .PG nc.i V
PROJECT NAME (Name of Business or Owner Last Name) {94,Il�C C "W/ 1.
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAME PRIMARY PHONE
WRING AD RE S CITY, STATE, ZIP
O
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
APPLICANT NAME
OFFICE PHONE
// q 9
( Y
MAILING ADDRESS
Co
LL PMONE
(
y flFF
MAILING ADDRESS
FAX NUMBER
❑ Architect ATenant ❑ Agent ❑ Other (Describe)
CITY, STATE, ZIP
CELL PHONE
St
co
1,2 (hq
( )
-
F FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
- -
-
- y
B
L
CONTRACTORS REGISTRATION NUMBER (copy of card required with each appUcationl
EXPIRA
N DATE
WIn LCQ LQ
�
9
_
l
l
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
// q 9
( Y
MAILING ADDRESS
CITY, STATE, ZIP `
LL PMONE
J
RELATIONSM TO PROJECT
FAX NUMBER
❑ Architect ATenant ❑ Agent ❑ Other (Describe)
NAME PRIMARY PHONE EMAIL ADDRESS
MAILING ADDRESS
EXISTING USE iI /\G f P tV\ , PROPOSED USE _ bu 1 Id /
EXISTING ASSESSED /APPRAISED VALUE % / J VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER XLAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
L
IQ
FIRST
ADDITIONAL FLOORS
NUMBER OF FLOORS
AREA DESCRIPTION
EIIISTISQ
Indicate number of each type of fixture to be installedl6r relocated
NECU4RICAL
/
Value of Mechanical Work $
SINKS
AIR HANDLING UNITS
RATIVE COOLERS
BBQS
XFIREPLACE
BOILERS
INSERTS
COMPRESSORS
CES
DUCTS
PE OUTLETS
BATHTUBS ,Tub /Shower Combo)
SHOWERS
DISH HERS
SINKS
PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom Sinks)
V�CUUM BREAKERS
as
PROPOSED
�1f Y
this project. Do not include
GAS LOGS
HOODS (Commarciaq
RANGES
GAS WATER HEATERS
WATER CLOSETS [roneq _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the Wormation 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 iq formation supplied to the city as a part of
this application.
NAME /TITLE NAP
f �4— ��\ %� ls� A. , " DAT r
J n t ( (Tide)
RELATIONSHIP TO PROJECT lR Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
Bulletin #100 — January 7, 2005 Page 2 of 4 k \Handouts\Permit Application
r
4% DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
4: PO Box 9718
CITY OF Federal Way WA 98063 -9718
(� 0 253- 835 -2607; Fax 253- 835 -2609 F del a y
www.cityoffederalwa
DEMOLITION PERMIT REQUIREMENTS
30(
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning
Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and
submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can
be issued.
❑ Prior to submitting a demolition permit, the following items (as applicable) must be signed by the respective
agency (see attached Demolition Permit Contact List).
NOTE To APPLICANT. Utilities shall be disconnected and services performed, if applicable, prior to issuance of the demolition permit. All applicable
items below are to be Wined and dated by the respective agency representatives...
t '
1. A ESTOS ABATEM T 6. ECTRICITY
(Cop f appro at form a stos survey from Puget Sound Clean Ai lectricity to be shut off and meter removed)
Age provid ) � O
(Puget Sound Energy)
j2. AS SUPPLY
( s to but off, eter removed and final bill paid)
(Pugef Sound Energy).
3. SEPTIC SYSTEM
(Tank to be removed or tank to be drained and filled)
(King County Environmental Services)
4. SANITARY SEWER (Check applicable box)
• Sewer line capped at property line
• Existing sewer line to remain and be used by proposed new structure
(Sewer District)
5.GARBAGE
(All household garbage disposed off and final bill paid)
(RST Disposal /Federal Way Dispc&al)
❑ Completed Construction Permit Application form
❑ Provide the following fees:
7. FUEL STORAGE TANKS
(Above or below grade fuel tanks, have been pumped or removed
under Fire Department permit prior to any dismantle /excavation)
(Federal Way Fire District #39)
S. WATER - Public Source (Check applicable box)
❑ Meter to be removed and final utility bill paid
o Meter to remain and be protected
(Water Supplier)
* * * * ** OR * * * * **
9. WATER - Private Well (Check applicable box)
o Private well filled and capped
o Private well to be used for other purposes
1. Demolition Permit Fee
2. Automation Fee
3. WA State Surcharge
4. Cash Bond Deposit
(King County Environmental Services)
$63.50
5.00
4.50
500.00 (Refundable upon Completed Final Inspection)
$573.00
Bulletin # 122 - March 9, 2005 Page 1 of I k.\Handouts\Demolition Permit Requirements
DEPAltTmzNT OF Commu my DEVELOPMENT SERviCn
_ _ ............... - ��- ...._.__.._._^�
33325 $ Avezlue South
CITY OF PU Box 9718
Federal Way
Federal Way Fax 3.835.970$
253- 835 -2607; Fa�c 253.835.2609
wwwxi offed way.com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's planning
division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and
submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can
be issued.
❑ Prior to submitting it demolition permit, the following items (as applicable) must be signed by the respective
agency (Bee attaehed Demolition Permit Contact List).
Nora rioAmucdNr: Utilities shall be disconnected and services perfor eA Vapplicable, prior to issuance of the demolition permit. All applicable
items below are to be ;lined and dated by the respective agency rept+esentatives.
1. ASBESTOS ABATEMENT 6. ELECTRICITY
•(copy of approval fpm, and asbestos survey from Puget sound Clean Air (eec biclty to be shut off and n'iew remavm)
a9y provided)
0
(City of Federal Way B,
2. GAS SUPPLY
(Gas to be Out off, meter removed and final bill paid)
et 5ourid EnvVy)
3. SEPTIC SYSTEM
(Tank tD be rerwiW tank t[► be drained and
(IQng County ErWorimentai Services)
4. SANITARY SEWER (Check applicable box)
• Sewer line capped at property line
• ExMng sewer line tri remain and be used by propo"d new sir cWr'e
(Sewer DOJVI)
S. GARBAGE
(al old garbage dl oI and Anal bill paid)
Disposal/Federal way I)
0 Completed Construction Permit Application form.
03 Provide the following fees:
Buktlrt 0122 - January 13, 2004
(P
7. RUIEL STORAGE TANKS
(Above or below grade fuel tanks, have been pumped or r+enumed
under Fire Department permit prior tD any dlsmande xmvation)
nr
Federal way lire Disbiet #39)
S. WATER - Public Source (Check applicable box)
❑ Meter to be removed and final utility bill paid ?9P //0 3 3 cy,,o
(Meter to remain and be protected
later suppler)
* * * * ** OR * * * * **
9. WATER - Private Well (Check applicable box)
* Private well filled and capped
❑ Private well to be used for other pu
King County
Envfthdierftl rvlces)
1. Demolition Permit Fee $61.00
2. WA State Surcharge 4.50
3. Cash Bond Deposit _500.00
$56550
(Refundable upon Campkted Floal Inspeefte)
rase I of 1 k.- \ranch m - RcAwdlDemoiition Permit "vimmna
a
09/05/2005 06:47 2534724 WMI DICKSON CO_
SEP -13 -05 TUE 02:25 PM EA ATE ENVIRQN, HEALTH FAX N0. G6
-111'
09/01/25115 87:55 2534724521
a
.�
Cl" of 4
Federal Way
WM AICKSON C0—
PAGE 02/03
Y. U4
PAGE 04/54
DSFAR7'bR>rK1r OF COT"t rrry A339Zd B� 9ZRVTCXff
PO Box 97 r 8
Federal Way WA 98063 -9718
253- e33.2607; Pax 253 -835 -2609
wwW clnroffodaralwa�
DEMOLITION PERM11 REQUIREMENTS
A demolidl in Wmit is requiimd to remove airy etmcture or Wa0h res an a subject properly. Check with the City's Planning
Division to got Iftli a ytvposal rxmeds thresholds ihartrigger an eryiromlncfoW wA, AIR envitenrneotal review and,
submittal o f art environmet►tal checklist vwy be tNuirsd, which will aftud the time Qtsritd bef0m a demolition permit can
be Ismad.
0 Prior tt sobmittin it dereatitlon permit, the following >l MS (ns xpplic'able) Most be signed by the r"Peclfve
aVtcy (gt a attAebed DOIRnllitan pcirmit Contact List).
Nn77sYIDA/f' Git. �/': [hflpfrn �lw1f be duco�ercd mrat sarwled'Asrf°r"'ed, ff°rFlirabln, pMot fo f9ruatlea of fha denooiitrort perrnri. All app!l09614
ft m: b4kw rre n be #="n"00 0Y rha mpectiw aseM7 Yzprwmfadva9 .
L-ASBESI DS ABATEMENT T (L tfttTto be 9Y
(CPY or apt � form and, art ".9 trL"Y from PAW Sound Clean Air (E1�#riclty to be sYtuC t►f! at►d meter re+nove�
� pm sau nerve
of peen 4V111 n9 OffldaV
7. Ft>Elr STPRAOE TANKS
21 W st PPI Y Abom or below grade ld tanks, hive been pumped or n+mo,+ed
(Gas m be thut OFF mdar rvnowd and final bill paid) under Plre Dapartteent Pemit prior to any dismende/exca"Wn)
t : sTb1M ink In! drain" and lAtcd)
+MCrlinentn �
4. S&W AR1. SEW" (Chec;k applicable hex)
Q 9c%w flr a Go ti* at Pimp" line
o LdWfig AWI r 1w% to remaln atd be used by vropoe44 new Ift"t'
3, GARD WE o!r>ind MCI bill R��
(All houml Bald larbsp �
IL WATER - Publ;v Source (Check appllrsble box)
a Metcr to b4 r'ernawd ano libel utility an PM
n Mater to remain and be proWtod
ate►
M+F�iN
OR eis*ws
9I WA'1RR� privrst0W1g1l (CheCk applicable box)
o private welt ruled and cwved
M PAVM! Wei to be Laed for other purposes
n¢
O Ce+++ aiet sd Constr4cf4as Permit Appli!44tion lolrnt
0 Provide :be followling 1, Demolition
t ae Free it Fee
I WA state Surebi"I"96
4, Cp_%h )nand Depoxlt
6a M A tx2 - MuWd14 Per
$63-50
5.00
4• S40. w Co Ioted VWPAI 1ns0ecti6n)
a0 (ReraadAbrn up*- mP
SS73.d0
DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 81h Avenue South
PO Box 9718
Federal Way WA 98063 -9718
253- 835 -2607; Fax 253- 835 -2609
www.cityoffederalwgy.com
DEMOLITION PERMIT REQUIREMENTS
A demolition permit is required to remove any structure or structures on a subject property. Check with the City's Planning
Division to see if the proposal exceeds thresholds that trigger an environmental review. An environmental review and
submittal of an environmental checklist may be required, which will extend the time period before a demolition permit can
be issued.
❑ Prior to submitting a demolition permit, the following items (as applicable) must be signed by the respective
agency (see attached Demolition Permit Contact List).
NOTE TO APPLICANT. Utilities shall be disconnected and services performed, if applicable, prior to issuance of the demolition permit. All applicable
items below are to be signed and dated by the respective agency representatives.
1. ASBESTOS ABATEMENT
(Copy of approval form and asbestos survey from Puget Sound Clean Air
Agency provided)
(City of Federal Way Building Official)
Q2. GAS SUPPLY
as to be shut off, meter removed and final bill paid)
(Puget Sound Energy)
(
3. SEPTIC SYSTEM
ank to be removed or tank to be drained and filled)
(King County Environmental Services)
4. SANITARY SEWER (Check applicable box)
• Sewer line capped at property line
• Existing sewer line to remain and be used by proposed new structure
(Sewer District)
.15. GARBAGE
(All household garbage disposed off and final bill paid)
(RST Disposal /Federal Way Disposal)
❑ Completed Construction Permit Application form
( ./ELECTRICITY
ectricity to be shut off and meter removed)
(Puget Sound Energy)
7. FUEL STORAGE TANKS
(Above or below grade fuel tanks, have been pumped or removed
under Fire Department permit prior to any dismantle /excavation)
(Federal Way Fire District #39)
8. WATER - Public Source (Check applicable box) d�
❑ Meter to be removed and final utility bill paid
' Meier to remain and be protected ai
(Water Supplier)
AAD-
******OR * * * * **
9. WATER - Private Well (Check applicable box)
❑ Private well filled and capped
❑ Private well to be used for other purposes
(King County Environmental Services)
❑ Provide the following fees: 1. Demolition Permit Fee $63.50
2. Automation Fee 5.00
3. WA State Surcharge 4.50
4. Cash Bond Deposit 500.00 (Refundable upon Completed Final Inspection)
$573.00
Bulletin #122 -March 9, 2005 Page 1 of 1 kA-Iandouts\Demolition Permit Requirements