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07-102199 ^1y r+ -- Community o Federal p`"services Burin - Commercial Perm#: 07-102199-00-CO g P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax(253)835-2609 Inspection Request Line: (253) 835-3050 Project Nance: AMERICAN FAMILY INSURANCE 7 Project Address: 31653 PACIFIC HWY S Suite C :2 Parcel Number 082104 9196 Project Description: TI-Install interior partitions,relocate restroom,new fixtures,added in restroom,relocate ductwork,add 2 new supply diffusers and 1 new return grille,drop existing lighting fixtures. Owner Applicant Contractor Lender HARSCH INVESTMENT HORIZON RETAIL HORIZON RETAIL AMERICAN FAMILY INSURANCE PROPERTIES LLC CONSTRUCTION CONSTRUCTION 6000 AMERICAN PKWY 1121 SW SALMON ST 1458 HORIZON BLVD HORIZRC072N5 4/15/09 MADISON WI 53783 PORTLAND OR 97205 RACINE WI 53406 1458 HORIZON BLVD RACINE WI 53406 J Census Category: 437 - Commercial alt/add Includes: #1 #2 #3 #4 crx•ancy Class: a` .s ction Type: Type V-B • art: 4K-40 City of Federal Way f • - Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. This certificate is valid ONLY when endorsed by City staff. Tenant Name: AMERICAN FAMILY INSURANCE Permit#: 07-102199-00-CO Address: 31653 PACIFIC HWY S SuiteC Includes: #1 #2 #3 #4 Occupancy Class: B Construction Type: Type V B Occupancy Load: 15 Floor Area(sq.ft.) 1,475 0 0 0 Owner Name: HARSCH INVESTMENT PROPERTIEf Owner Address: 1121 SW SALMON ST PORTLAND OR 97205 Building Official Date The priority focus in the review and inspection made by the City prior to issuance of this Certificate was on those matters which experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. aS DATE INSPECTOR AREA AND TYPE (►. INSPECTION `�',3 c5 7 G�-�°"� ��v told-// Cry c( t ' ~ ' t THIS CARD IS TO MAIN ON-SITE CITY OF itommunitY p Inspection elo m nt Ins ection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 07-102199-00-CO Owner: HARSCH INVESTMENT PROPERTIES LLC Address: 31653 PACIFIC HWY S Suite C FEDERAL WAY, WA 98003 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. O Footings/Setback(4110) ❑ Re-steel(4215) ❑ Plumbing Groundwork(4190) Approved to place concrete Approved to place concrete or grout Approved to cover By Date By Date By Date ❑ Slab/Concrete Floor(4255) 0 Underfloor Framing (4285) ❑ Floor Sheathing(4105) Approved to place concrete Approved to sheath floor Approved to install flooring By Date By Date By Date ❑ Rough Plumbing(4230) •❑ Mechanical Rough-in (4165) ❑ Gas Piping(4125) Approved A proved / Approved to release test ByDate By `! Date // ByDate . // Fire/Draft Stops(4095) / Framing4120 0 P NOTE: Prior to scheduling a Framing(4120) ❑ ( ) Approved inspection;Electrical,Plumbing&Mechanical Approved to insulate Rough-in and Fire/Draft Stop inspections must be By Date signed-off and approved. IBC 109.3.4/UBC 108.5.4 By�ecf Date s---A, -If) El Insulation(4150) 0 Gypsum Wallboard Nailing(4130) ❑ Suspended Ceiling Grid(4265)// Approved to install wallboard Approved to install mud&tape Approved to drop tile By Date By G to3 Date5",3. 0 7 By Date`''== ❑ Final-Fire Department(4060) 0 Final-Planning(4070) ❑ Final-Mechanical(4065) Approved Approved Approved � By Date By Date By ���' Date 54/ 0J ❑ Final-Plumbing(4075) ❑ Final-Building(4050) ` Approved Approved By Date By 4/ 5 Date 6jidlo7 RECEIVED EIVED n - t 0 -1 4 61 CITY OF Federal Way APR 2 4 2007 PERMIT SF MF 6 ME EL PL DE EN FP COMMUNITY DEVELOPMENT SERVICES 33325 811'AVENUE SOUTH•PO BOX 9718 RAL A7•Y, XWA 25938086335-9�Ty OF FEDE ,A�LI CATI O N TD 2F5E3D-8E35-26W0 /O —r /www. BUILDING DEPT. ciWoffederal watt.com The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. • PROPERTY INFORMATION SITE ADDRESS ,3 I CoD POJ C_. ClG�1(-, u( a..-- ('\�- SUITE/UNIT# 0_, ASSESSOR'S ASSESSOR'S TAX/PARCEL# 0 8 , I 0 1�- l 1 et` (C,p �,� CoT`SIZE, (sf I LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) Pct)1 It 1 n1/\'s .'1_ Sv 1 O f)0 l► ! ` vcSIe_) (Attach separate page for lengthy Legal description) • PROJECT INFORMATION �J TYPE OF PERMIT 04.BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM PROJECT DESCRIPTION(Provide detailed description of work included on this permit only) „i S-c1.l( ,vii ear i Ci C -4z k i©r / r e I c e__ r{9 7A-c-r r-,w•,f F i k-tithe S ac1eC re S-1 h tart, 141) 110;4- ;s Q K,S-l-i n? on S/4c . . Lk-A_ (.0,1( c (ocEt el LLc-�c(�-t 6cid .-- i'i ) 14 4S 14 (9 d..- F . s,L I L r d- ri 'rrt i 1 / rt.loc cck...a b4•iY1 4t&,v1 4 PROJECT NAME(Name of Business or Owner Inst Name) ("7 mQ-V-L C_OLY\ 'vY)t 1 l.( r/ThLL('CuAcg_, • PEOPLE INFORMATION l PROPERTY iNAME ` j� ) PRIMARY PHONE i-7 OWNER k-tO S(\ aR0Q_Cklfr,Q,lr- Pt-gii -k-le`� LLL (5103) 3 -331 I MAILING ADDRESS C ,STATE,ZIP E-MAIL ADDRESS CONTRACTOR COMPANY NAME APP ANT NAME OFFICE PHONE 14 o r;Irv, i e ik Co vl`a',-+; `Wotr. cx e.,)f(►Dina (A )50(-4 -4,140 MAILING ADDRESS C .STATE,ZIP CELL PHONE 1 L{5S l;-4Of�Zcti-UI JCS -.1. 0._,..1%-x_____, wt. .53,fd(,, ( ) - CITY//OFF FEDERAL WAY BUSINESS�1LICENSEICNUMBER IRAIOON DA/1/'�J'� FAX NUMBER ��y/��� L/C O� - (Ol l� [JC7'— 3�>L ' / D/ V E4 )5o -`(; .� -MAIL ADDRESS COPY of card nquirea (/�CONNN'"1��22EAAA(C1 IS OR'S REGISTRATION NU$I t�-/� �F1 /SEXPI (, with each applleatlon `C— J 1 { 1 c��z F\C . o C \ 5 1 W/5/ 1 APPLICANT COMPANY NAME f.‘ �l APPLICANT NAME OFFICE PHONE }-{o cN azo%n s')-Acs;\ COLI ru. 1.1 (Ao.z) so'/ -(D I clO MAILING ADDRESS f.IV,STATE,ZIP CELL PHONE iy5a NotZZ.o0 YoI()ct. ac_%,& Ca- , s346(0 ( ) - RELATIONSHIP TO PROJECT / FAX NUMBER ❑ Architect 0 Tenant 0 Agent igt Other G,.,, rsc r,r (p?(9)504 -(Oj PROJECT /� ` PRIMARY PHONE E-MAIL ADDRESS CONTACT '7C) "4--c5 L.J(‘►PV1O4(1C7\ (02o) 50 -6,140 rcr-- cI'iZLAr,Q il.,cvrt LENDER NAME Per RCW 19.27.095: Ny Akirk.wc V-1 vl, utff-V15, Lender information is required if project value exceeds$5,000 MAILING ADDRESS Y-�� D Y,STATE,ZIP PHONE �O Au u'u-c ,AA PK4-c) I\lad t ov1, La_.531783 (4 )2La -Woo NI DETAILED BUILDINGCINFORMATION /� EXISTING USE Ma-19 lZ MOOS J-c&Cr4 Cary 5`la0 PROPOSED USE t-tdYl4t r itC VI Varr1e ItieLi4V. ()PRO_ EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 50, OW eCTO" SPRINKLERED BUILDING? ES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES )4110 WATER SERVICE PROVIDER t�AKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL) PSS RR SERVICE PROVIDER 0EHAVEN " ❑ HIGHLINE ❑ PRIVATE(SEPTIC) 1\r ervJA", • PROJECT FLOOR AREAS AREA DESCRIPTION EXISTING PROPOSED TOTAL SQ.FT. SQ.FT. SQ.FT. BASEMENT �' FIRST )t'-1]c (( u � J 1(-0'(; SECOND THIRD ADDITIONAL FLOORS(DESCRIBE) DECK(❑COVERED OR ❑UNCOVERED?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS EXISTING PROPOSED TOTAL TOT AL EXISTING SF TOTAL PROPOSED SF TOTAL SF **NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ • FIXTURES 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 Value of Mechanical Work $ C<I9 o....'"1.V (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC(Describe) BOILERS FIREPLACE INSERTS HOODS(commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG.SYSTEMS PLUMBING BATHTUBS(or Tub/Shower Combo) ` LAVS(Bathroom Sinks) URINALS MISC(Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS i WATER CLOSETS (Toilet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS SIGNATURE 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 flied 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. (....„---2 �_! o NAME/TITLE SL �v _ iJ DATE d1 -FR-CTI (Signature) (Title) RELATIONSHIP TO PROJECT 0 Owner 0 Agent N Contractor ❑Architect 0 Other ❑NEW o ADDITION o ALTERATION ❑REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? ❑YES o NO BASIC PLAN? ❑YES ❑NO ZONING DESIGNATION CHANGE OF USE? o YES ❑NO NEW ADDRESS REQUIRED? o YES ❑NO UP/SEPA/SU? o YES ❑NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO Bulletin#100—January 1,2007 Page 2 of 4 k\Handouts\Permit Application