11-104877i Mr , a
City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835 -2607 Fax: (253) 835 -2609
L sr
�Building ,..commercial
Perilit #: 11- 104877 -00 -CO
Inspection Request Line: (253) 835 -3050
Project Name: CITY ON A HILL CHURCH
Project Address: 1336 S 336TH ST Parcel Number: 926503 0040
Project Description: TI - Interior repairs and renovations for new church tenant, including roof repair, door
and window infill/relocation. No plumbing or mechanical.
Owner
Applicant
Contractor
L n er
ROBERT GOODMAN
RODDY NOLTEN
TENANT IS CONTRACTOR
TIM CHERGAROV
R J N & ASSOCIATES
Construction Type:
Type V - B
CITY ON A HILL CHURCH
1220 S 356TH ST SUITE A -3
Occupancy Load:
1336 S 336TH ST
FEDERAL WAY WA 98003
FEDERAL WAY WA 98003
1 1,000
1 0
0
Census Category: 437 - Commercial alt / add / conversion
Includes:
#1
#2
#3
#4
Occupancy Class:
B
Construction Type:
Type V - B
Occupancy Load:
Floor Area (s q. ft.)
1 1,000
1 0
0
0
Existing Sprinkler System in Building ? .................No
Number of Stories .................... ..............................1
Plumbing to be Included? .......... .............................No
Occupancy # 1 - Use ................ ............................... Church
Mechanical to be Included? ........ .............................No
Permit for Building Shell Only? .............................No
New / Additional Sq. Feet - Total .......................... 0
PERMIT EXPIRES Wednesday, June 6, 2012
Permit Issued on Friday, December 9, 2011
I hereby certify that the above ! is is correct and that the construction on the above described property and
the occupancy and the use'WilI be in cordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way.
Owner or agent: Date: 12
FINp"Ou It /141/1Z
THIS CARD IS TO MAIN ON ,SITE
Cl" OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253) 835 -3050
PERMIT #: 11- 104877 -00 -CO Address: 1336 S 336TH ST
Project: ROBERT GOODMAN FEDERAL WAY, WA 98003 - 6348''
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.
El
SWM Precon Site Mtg (4400)
E]
Initial Erosion Control (4365)
Slab /Concrete Floor (4255)
Footings /Setback (4110)
Approved
By
To be done prior to breaking ground
Approved to place concrete
By
Date
By
Date
By
Date
El
Re -steel (4215)
Slab /Concrete Floor (4255)
Underfloor Framing (4285)
By
Approved to place concrete or grout
By
Approved to place concrete
By
Approved to sheath floor
By
Date
By
Date
By
Date
Floor Sheathing (4105)
Approved to install flooring
By Date
Fire/Draft Stops (4095)
Approved
By Date
Interim Erosion Control (4370)
Approved
By Date
Prior to scheduling a Framing inspection; Framing (4120) 0 Insulation (4150)
Electrical, Plumbing & Mechanical Rough -in and Approved to insulate Approved to install wallboard
Fire/Draft Stop inspections must be signed -off and
approved. IBC 109.3.4 By Date ` By Date
Gypsum Wallboard Nailing (4130)
Approved to install mud & tape
By Date
Final - Planning
Approved
By Date
E] Suspended Ceiling Grid (4265)
Approved to drop tile
By Date
Final Erosion Control (4375)
Approved
By Date
Final - Fire Department (4060)
Approved
By /bZ Date
Final - Building (4050)
Approved
By 6oe::' Date /f_/,�'7
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
nor r *ERMIT
Fe
r
COAIAAINITY DEVELOP mEmrs %as r APPLICATION
253- 835 -2 FAX 253 2 9 "
r, era u r'rh iFrcJug {L_rrr \/
_,ry
SITE
PROJECT VALUATION
V .7Z 1�� I
TYPE OF PERMIT
NAME OF PROJECT
(Tenant Name /Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
PLICANT
PROJECT CONTACT
/The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
Required value of $5,000 or more
/RCW 19.27.095)
ZONING
ASSESSOR'S TAX /PARCEL #
?�C' q- Z— L-
KBUILDING ❑ PLUMBING
❑ DEMOLITION 0 ENGINEERING
Ci � oA) A t4i LL C
NAME
MAILING ADDRESS..—
SF F CO ME PL DE EN FP
9-703-—
❑ MECHANICAL
❑ FIRE PREVENTION
SUITE /UNIT #
WEN
PRIMARY PHONE
crt t 31/`��� l ��
tPQ C,
((�j � l �i
MAILING ADD
! oa A 0).
EMAIL
C _ $1h►'I'$
A
FAX
WA STATE CONTRACTOR'S LICENSE
EXPIRAT,IOONN DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
( g `
PG+ % r-? — O 3a -
L
MAi IINGI ADDRESS
3-3M4 -
EMAIL
C
1. STA
,[jam.
73 8'� L / iz
MAI NG ADDRESS
13 5
E -MAIL
I
NTA'I L
__
FAX
ALTERNATE CONTACT NAME. ' 1 PHONE I E -MAIL
L � T4 l ®�L L _l I /` OWNER-FINANCED
t, STATE ZIP PHONE
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. 1 certify that I will compty 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:
1 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 Z part oft a lication.
SIGNATURE: j�' DATE .Z /
j.�� .r -1)
1
PRINT NAME:
Bulletin 4100 — January 1, 2011
Page 1 of 3
kAHandoutsTermit Application
0
VALUE OFMECRAMCAL WORK $
(a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project- Do not include existing futures to remain.
AIR HANDLING UNITS FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS
HOODS jc...*_c )
BOILERS FURNACES
„ ":, HOT WATER TANKS (caz)
COMPRESSORS GAS LOG SETS
REFRIGERATION SYST
DUCTING, GAS PIPING
WOODSTOVES
Indicate how many of each type. of fucture to be, installed or relocated, as part of this project- Do; not include existing firtures to remain.
BATHTUBS jw Tas /sr6w: C=bel LAVS (Hand skA.)
TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS,
URINALS r OTHER (Describe) °
DRAINS SHOWERS
T_ VACUUM`BREAKERS
DRINKING FOUNTAINS SINKS (Kiwhm
WATER HEATERS (Ei«mc)
HOSE BIBBS SUMPS
WASHING' MACHINES
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
CRITICAL AR%E�AS. ON PROPERTY?
414)
4
EXISTING /P . OII 3
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
Yesx, NO
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes No
/S
`'�D�v
I
PROPOSED
TOTAL
FOR OFFICE USE
AREA DESCRIPTION (in square feet)
EXISTING',
FIRST FLOOR (or Mobile Home)
® ®�
gg
�nAy a
COVERED, ENTRY
GARAGE 0 CARPORT 0
Area
EXISTIR6 PROPOSED
PRICE $ 1 # OF
Bulletin #100 —January 1, 2011 Page 2 of 3 k_\Handouts\Permit Application