06-100821 # I
CommunityDeveopmeof Federal nta*rvices Building - Commercial Permit #: 06-100821-00-CO
P.O.Box 9718
Federal Way,WA 98063-9718 -
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253)835-3050
Project Name: LIFE CARE CENTERS OF AMERICA
Project Address: 33801 1ST WAYS Suite 301 Parcel Number: 926504 0160
Project Description: Installation of a total of(3) new walls to create (2) suites from (1)large suite.
Owner Applicant Contractor Lender
STAN KLEWENO SUPERIOR BUILDERS INC SUPERIOR BUILDERS INC
TRANSPACIFIC INVESTMENTS PO BOX 1849 SUPERBI112D2 3/4/07
101 SW MAIN ST SUITE 350 MILTON WA 98354-1849 PO BOX 1849
PORTLAND OR 97204 MILTON WA 98354-1849
Census Category: 437- Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class: B B
Construction Type: Type V-B
pancy Load: 24
rea(sq. ft.) 76 2,390 0 0
Additional`Pert t Information
Existing Sprinkler$yste in Buildin�k Yes Mechanicall Ittcl d? o
Number of Stories Permit for Building Shell Only? No
Plumbing to be Included? No Occupancy#1 -Use Professional
Services/Offices
Sensitive Areas?(Wetlands/Slopes,etc) No Zoning Designation OP
No Fixtures Associated With This Permit I.
CONDITIONS:
PERMIT EXPIRES Thursday, March '13, 2008
Permit Issued on Monday, March 13, 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 in accordance with the laws, rules and regulations of the State of Washington
and the Ci of Fe.- al Way.
g , 7/o7
Owner ora agent: /�� � � Date:
'ty of I ederal Way le
Certificate of Occupancy 14
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: LIFE CARE CENTERS OF AMERICA Permit#: 06-100821-00-CO
Address: 33801 1ST WAY S Suite301
Includes: #1 #2 #3 #4
Occupancy Class: B B
Construction Type: Type V-B
Occupancy Load: 24
Floor Area(sq. ft.) 76 2,390 0 0
Owner Name: STAN KLEWENO
STAN KLEWENO
Owner Name: SUPERIOR BUILDERS INC
Owner Address: PO BOX 1849
MILTON WA 98354-1849
• »1imigoi CdD -7/4/0k
Building Official f'th `�� 7/3/ e
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.
J
THIS CARD IS (14IEMAIN ON-SITE
CITY OF tommunity Development Inspection Record
Federal IVR INSPECTION REQUEST �NE
# (253) 835-3050
PERMIT#: 06-100821-00-CO
Owner: STAN KLEWENO
Address: 33801 1ST WAY S Suite 301
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) ❑ Slab/Concrete Floor(4255)
Approved to place concrete Approved to place concrete or grout Approved to place concrete
By Date By Date By Date
❑ Underfloor Framing(4285) ❑ Floor Sheathing(4105) ❑ Fire/Draft Stops(4095)
Approved to sheath floor Approved to install flooring Approved
By Date By Date By Date
•
. ✓n NOTE: Prior to scheduling a Framing(4120) Framing(4120) 0 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 \1
By1 �� Date3\-- kag By Date
❑Gypsum Wallboard Nailing(4130) �❑ Suspended Ceiling Grid (4265) ❑ Final-Fire Department(4060)
Approved to install mud&tape Approved to drop tile Approved
1331C--ti Date ® 11 0By Date By L3 Date 3./c/../e.
❑ Final-Planning(4070) ❑ Final-Building(4050)
Approved Approved
By Date By / -----41- Date Wei
• RECEIVED • 1-1 (10
CONSTRUCTION PERMIT APPLICATION
-A �F1iRL FEB 2 1 2006 APPLICATION NUMBER: 042 i QQ i -(Y�,
APPLICATION NUMBER _ --
• CITY OF FEDERAL WAY APPCICATION NUMBER -
BUILDING DEPT.
**The following is required information-Please print(in ink)or type**
Please note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application.
• PROPERTY INFORMATION
ER
SITE ADDRESS: - - 0 / / -7-
t/0/1--)e ./
r C. L ASSESSOR'S TAX/PARCEL#:1
A. }o C 0 V - d L 0
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): 4- -{-6_c_ke 44
• PROJECT INFORMATION
TYPE OF PROJECT(This application): +BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION
o ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description): C-t`e- 6. s` -` 1-e.. rl-,-,•.--t 6)
PROJECT NAME: L-j-C_ l-Art C..- Cet 4 e`r'- - o 4" 4' - --i _
III • PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
�'[V\ ( r k(\ 5 F/4-G ie- I m v e,S�r-2� c, (as-3)7z-z_ - /,-( -7
MAILING ADDRESS(STR AD RESS;CITY,STAT ,ZIP):
l ao l l/)-C , AL. e , i ..`TA e_ /'- 0 1'--c 9 g 1(o z.
CONTRACTOR: NAME' DAYTIME PHONE:
t/lr_�(dt - i i Xe-f�S , I- L (23) £7
-/bels
MA55SS;CITY,ST .ZIP):/ EVENING PHONE:
jtO` 20 ( CJ , 10/0CS ! V3S ( 1zS ) 3S - 1 `b f
QTY OF FEDERAL WAY BUSINESS LICENSE NUMBER:
FAX NUMBER:
- (A5 )C7� - )7417
CONTRACTOR'S REGISTRATION NUMBER: Q ]� '''j' / ^� EXPIRATION DATE:
(copy of card required) S (& P 1 '\ tS,3 � i e'`� P 2, 'Z / q /
DAYTIME PHONE:
PPLICANT: NAME• � 1 ( )
-
jl?1�,�� % _�f�15�1�'/� 7
N"ri rur_! ^ cc I T AO ADDRESS:CITY,STATE,ZIP): EVENING PHONE:
/20/ Jar:, /di S'u�? //7400 rac, f 82- ( ) -
R TI NSHIP TO PROIECT: FAX NUMBER:
❑ARCHITECT ❑TENANT o OTHER(DESCRIBE): ( ) -
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER jI(APPLICANT d(CONTRACTOR
(+ t7
• DETAILED BUILDING INFORMATION �
EXISTING USE: 6 T4i-cc( C-C EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ ,S�/
• 0O 0
PROPOSED USE: O PROPOSED VALUATION FOR IMPROVEMENTS: $ r'29/006
SPRINKLERED BUILDING? `YES a NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED,YES 0 NO
WATER SERVICE PROVIDER: VLAKEHAVEN ❑ HIGHLINE ❑TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: V-LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• • dr
i
**NEW RESIDENTIAL CONSTRUCTION ONLY** •
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
•
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HA'• - • UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S
BOILER(S) •EPLACE INSERT(S) RANGE(S)
COMPRESSOR(S) FUR • do
DUCT(S) GAS PIPE OUTLET .i• SOURCE: o ELECTRIC ❑GAS
• ' 'BING
BATHTUB(S) •VATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECT• - ❑ GAS
DRINKING F• •IN(S) SHOWER(S) WASH MACHINE OUTLET
GAS • - •UTLET(S) SINK(S) WATER CLOSET(S) MISC.(
•TERCEPTOR(S) SUMP(S)
■ 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 .m authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree t hold harmless th• -• • ederal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the
investigation a • •efe -- of su im),w'•ch may be made by any person,including the undersigned,and filed against the City of
Federal Way,b Aonl h�~�, claim ar' out of the reliance of the city,including its officers and employees,upon the accuracy
itriP
of the informal' sW,•'li i ,:�a pa •f this application.
NAME/TITLE: �,1�,�� � '' ; " DATE: i870�
❑ PROPERTY 0 ,R ■ • •PLICANTCONTRACTOR
FOR OFFICE USE ONLY:
0 NEW ❑ADDITION ❑ALTERATION ❑ REPAIR TENANT IMPROVEMENT
CENSUS CODE: P LOT SIZE:
ZONING DESIGNATION: 0 BUILDING SHEL ONLY? Y NO III
COMP PLAN DESIGNATION BASIC PLAN? ❑YES N
SECTION TO NSHIP RANGE NEW ADDRESS REQUIRED? ❑ Y NO
PLATTED LOT? ES o NO CHANGE OF USE? ❑YES 0
a
COMMUNITY DEVELOPMENT RVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•2 3-661-4000•FAX:253-661-4129
ri vr.c;tvoffederalway.com