10-103879 '' # 3uilding - Single Family
City of Federal Way + ./.�
Community Development Services Permit #: 10-103879-00-SF
P.O.Box 9718
Federal-260, Fax
(253)9718
835- Inspection Request Line: (253) 835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p Q
Project Name: JACOBSON a??3 a
Project Address: 32225 23RD AVE SW Parcel Number: 873180 0100
Project Description: REP-Tear off existing shake roofing,install plywood sheathing and composition shingle
roofing system.
Owner Applicant Contractor Lender
WILLIAM&CAROLYN WILLIAM&CAROLYN 32225 23RD AVE SW WILLIAM&CAROLYN JACOBSEN
JACOBSEN JACOBSEN FEDERAL WAY WA 98023-2504 32225 23RD AVE SW
32225 23RD AVE SW 32225 23RD AVE SW FEDERAL WAY WA 98023-2504
FEDERAL WAY WA 98023-2504 FEDERAL WAY WA 98023-2504
Census Category: 565 - Fence/retaining wall
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
s ,ir 1ddi at rmit o�tio
Axa ;!
New/Additional Sq.Feet-3rd Floor 0 New I Additional Sq.Feet-Basement 0
Mechanical to be Included? No Plumbing to be Included" No
Fixtures Associated With This Permit!!
•
.?. „s4,F
PERMIT EXPIRES Saturday, March 12, 2011
Permit Issued on Monday, September 13, 2010
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
• the City of Federal Way.
Owner or agent: - 1P-11111, Date: 1a2 /l
N-ck- Lxo q :+ to
4.11 414 1%..... '
THIS CARD IS TO r AIN ON-SITE
CITY OF Construction Ins ction Record
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 10-103879-00-SF Address: 32225 23RD AVE SW
Owner: WILLIAM & CAROLYN JACOBSEN FEDERAL WAY, WA 98023-2504
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 SWM Precon Site Mtg(4400) 0 Initial Erosion Control (4365) 0 Underfloor Framing(4285)
Approved To be done prior to breaking ground Approved to sheath floor
By Date By Date By Date
Floor Sheathing(4105) El Shear Walls (4245) El
Roof Sheathing(4220)
Approved to install flooring Approved to install siding Approved to install roofing
By Date By Date By �� Date 74340
•
El Fire/Draft Stops(4095) 1:1Interim Erosion Control (4370) Prior to scheduling a Framing inspection,
Approved Approved Electrical,Plumbing&Mechanical Rough-in and
Fire/Draft Stop inspections must be signed-off and 1
By Date By Date approved. IBC 109.3.4
El Framing(4120) 0 Insulation (4150) O Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By Date By Date By Date
0 Final Erosion Control (4375) Final-Building(4050)
Approved Approved
By Date By Date t� _l —I',
•
❑ Rough Electrical Final Electrical Right of Way
Appmv ed Approved Approved
By Date By Date By Date
_ _ � 03 ' 7q
Federal Way (PERMIT =- '. F s .�. ,
,, r. F CO ME PL DE EN FP
APPLICATION 6
COMMUNITY DEVELOPMENT SERVICES , a '� "
253-83.5-2607•FAX 253-835-2609
n•ua,:auml'icrl^r0::r¢iarm i
CI
I SITE ADDRESS TY OF FEDERAL WAy SUITE/UNIT#
,� 2 J g---3 4e t S, Ccs.. f--,--eU,y,�rQDse 1 ,: ; /0 A
PROJECT VALUATION(£OO r ZONING ASSESSOR'S TAX/PARCEL#
4,4
TYPE OF PERMIT S..3UILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) 'J e7( Ci b S
PROJECT DESCRIPTION C ��� /` '� ��° t
Detailed description of work to >Z,--e--?�• d
be included on this permit only
NAME 1 T- PRIMARY PHONE
PROPERTY OWNER 'ELL( —ea (
r �ar� a-e-F IJ-r1t-
MAILING ADDRESS u� E-MAIL
2a7' 02.3 tf(9r) Z
CITY STATE ZIP
NAME V` ) PI
-----l~
L !C,> LL_ C.4 .7A., p-1-4-e- --.w. 5,3--.3c2,-/,5Z-`.
MAILING APDRESS E-MAIL •
CONTRACTOR 7-4
' '�" /307/1 ��
CITY / - e -' STATE-,1 ZIP/'(1 i FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
•
1 ` (- �. t- i•- . /
NAME C1 't PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT ( NAMEE PxoNE
(The individual to receive and L
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) I
CITY 7-7-'-'
STATE ZD'
.
ALTERNATE CONTACT NAME PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27095) MAILING ADDRESS,CITY,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. I certify that I will comply 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.
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,
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. )
/ �,r 3 " t '(C'
SIGNATURE: % ., �" ' �� - DATE ` — l
PRINT NAME: e 1 4 ' v./ ,T--,c..6.oh r
Bulletin#1 -April 14,2010 Page 1 of 3 k:\I-Iandouts\Pemut Application
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VALUE OF MECHANICAL 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 fixtures to remain.
AIR HANDLING UNITS FANS :+ -j GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(CommercieU
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST •
DUCTING GAS PIPING WOODSTOVES
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Indicate how any of each type of fixture to be installed or relocated as part of this projec Do not include existing fixtures to remain.
BATHTUBS r Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHE RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUU BREAKERS
DRINKING FOUN INS SINKS(Kitchen/Utility) WAT HEATERS(Ekctiic)
SUMPS WA ING MACHINES z::'L?`F`iti:l:'::R`f l't ft 5��iiiz% �:
HOSE BIBBS ':''``»::'
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CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
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$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTIN,ri FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
/ ❑ Yes❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY N
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GARAGE 0" CARPORT 0
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" "" EXISTING PROPOSED '+, TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ i # OF BEDROOMS
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Area Construction #of
AREA DESCRIPTION • OccupancyGrou s Additional Information
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ADDITION \
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AREA DESCRIPTION Area Occupancy Group(s) Construction #df Additional Information
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TENANT AREA ONLY
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Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application