06-103847 .7
RECEIV4 _
CITY OF 12 /� --
Federal Way '/ / �(
COMNUNIYDEVELOPMENTSERVICES" "° 0 OO PERMIT '� SF MF CO ME EL PL DE EN FP
33325 8n•AVENUE SOUTH•PO BOX 9718 _-n`���
253 161/01.1
07 FAX 253 974TY OF FEDEI 1VP`P L I C AT I ON �° g / -� /
www.a.fedemlwnu•com BUILDING DEPT.
The ollowing is required information-an incomplete application will not be acce.ted. Please .tint legibly in ink)or ty.
III PROPERTY INFORMATION
SITE ADDRESS -T /,' / ,1 � \/1) SUITE/UNIT#
ASSESSOR'S TAX/PARCEL# 0 D S ■ v v - 0 ( J (7 LOT SIZE(s)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page fat lengthy legal desoiptian)
■ PROJECT INFORMATION
TYPE OF PERMIT [BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
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PROJECT NAME(Name of Business or Owner Last Name) /V Fh H 6D'C V ZC
MI PEOPLE INFORMATION
PROPERTY NAME c PRIMARY PH E
OWNER /L /,/q �N HE/f/ F / V/,2! _ P.� )X79 - 2.G/
MAILING ADDR .. CITY, ATE,
0 Li l?-- �,(e sly' Fectero (ill y Wicfr 949°Zg
CONTRACTOR COMPANY NAME APPUCANT NAME 7 OFFICE PHONE
MAIILAD
O ADDRESS CITY,STATE,ZIP CELL PHONE
■ ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
- - - / / (
B L
CONTRACTORS REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAIL0VV►►��__//rr
�� 0
ADDRESS ' CITY,STATE,ZIP CELL PHONE
(
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect ❑Tenant ❑Agent ❑ Other(Describe) ( ) -
CONTACT NAME „y r , PRIMARY PHONE E-MAIL ADDRESS
/ J. I'M li 11�%Amd()vi(' (...N _17 - Y. ' /
LENDER NAME
MAIUNO ADDRESS CITY,STAZIP� ' PHONE
( ) -
■ _DETAILED BUILDING INFORMATION
EXISTING USE -' I V\:-l t L.),,.,,,•',_ [NC V1r• = PROPOSED USE fI 114:,.Ci' kc4\ .&\kic Fib
EXISTING ASSESSED/APPRAISED VALUE $ 2_0(...)/g''pCI VALUE OF PROPOSED WORK $ • J
SPRINKLERED BUILDING? ❑ YES G\NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES c\NO
WATER SERVICE PROVIDER ,(LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE d\PRIVATE(SEPTIC)
1
i
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ. FT. SQ. FT. SQ. FT.
BASEMENT
FIRST
1
SECOND
THIRD
FOURTH
ADDITIONAL FLOORS(DESCRIBE]
DECK(COVERED?)
GARAGE 0 CARPORT 0
TOT
N
NUMBER OF FLOORS PR AL
**NEW HOMES ONLY'** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be insta -d or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS /r. EVAPORATIVE COOLERS GAS LOGS REFRIG.SYSTEMS
BBQS / FANS HOODS icommerci.fi'... WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES MISC(Describe)
COMPRESSORS FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub owerCombo) SHOWERS WATER CLOSETS(Tao MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPFjOUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(g*ry,00msink.) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK .
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,i luding its officers and employees,upon the accuracy of the information supplied to the city as a part of
this application.
NAME/TITLE l "C/"6 Zj i / DATE U,Q
.- 2 -oS
(Signature) (Title(
RELATIONSHIP TO PROJECT ci Owner ❑Agent ❑ Contractor ❑ Architect ❑ Other
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Bulletin#100-January 1,2006 Page 2 of 4 k\Handouts\Permit Application
City of Federal Way Building - Single Family Permit #: 06-103847-00-Sr
community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (2511835-3050
Project Name: MEHMEDOVIC
Project Address: 30425 21ST AVE SW Parcel Number: 005100 0130
Project Description: REM-Replace roof structure wi e re-engineered truss system.
Owner A licant Contractor Lender
NERMIN MEHMEDOVIC IN ME E►i VIC 30425 21ST AVE SW NERMIN MEHMEDOVIC
30425 21ST AVE SW 30425 21ST A ' SW FEDERAL WAY WA 98023 30425 21ST AVE SW
FEDERAL WAY WA 98023 EDERA AY 98023 / FEDERAL WAY WA 98023
Census Ca go • 4 - ' esidential It/ad o ch ge i tuber of units
Includes: #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
,r Area(sq.ft.) l 0 0 0
w
iAdditional � m
'�a �'
New/Additional "Feet-3rd Flood_..... New I Additional Feet-Basement .....• 0
Mechanical to be Included?. No Plumbing to be Includes .NO
�
No Fixtures Associated With This Permit I!
PERMIT EXPIRES Friday, August 15, 2008
Permit Issued on Tuesday, August 15, 2006
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 accordance with the laws, rules and regulations of the State of Washington
and th= Cityof Federal Way.
404 • f
• r - a•= . Date:
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ScoJ't/4v5s 3fit4 ( 1?--
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41ITHIS CARD IS TO REMAIN ON-SITE
CITY OF '� — �� Community Development Inspection Record
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 06-103847-00-SF
Owner: NERMIN MEHMEDOVIC
Address: 30425 21ST AVE SW
FEDERAL WAY, WA 98023-2306
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.
0 Temp.Erosion Control (4365) ❑ Underfloor Framing (4285) 0 Floor Sheathing(4105)
To be done prior to breaking ground Approved to sheath floor Approved to install flooring
By Date By Date By Date
El Shear Walls(4245) .Li Roof Sheathing(4220) ❑ Fire/Draft Stops(4095)
Approved to install siding Approved to install roofing Approved
By jai'" Date 9 ,a‘ ,By 17/1 Date 9 , & • By Date
NOTE: Prior to scheduling a raming(4120) ,❑ Framing( 12 ❑ Insulation(4150)
inspection;Electrical,Plumbing&Mechanical Approved to insulate Approved to install wallboard
Rough-in and Fire/Draft Stop inspections must be �� �J /
signed-off and approved. IBC 109.3.4/UBC 108.5.4 ' /� V"/ T///DC,
By Date � By Date
❑Gypsum Wallboard Nailing(4130) ❑ Final-SWM(4375) ❑ Final-Building(4050)
Approved to install mud&tape Approved Approved
By Date By Date By Date
❑Temp. Erosion Maintenance(4370)
Approved
By Date