07-104039 •
,. City of Federal Way Bul�ln
Cornmunityt)evelopmentServiceslidg - Commercial Perm#: 07-104039-00-co 39-00-
C
Federal Way,WA 98063-9718
Ph.(253)835-2607 Fax.(253)835-2609 nor _aa1 Inspection Request Line: (253)835-3050
Project Name: WASHINGTON STATE LOTTERY OFFICE
Project Address: 33701 9TH AVE S SW.d Parcel Number: 926480 0190
Project Description: TI-Interior modifications for new tenant including partition walls and one additional
break room sink. Mechanical work on separate permit.**added (2)plumbing fixtures on
8/10/07**
Owner Applicant Contractor Lender
SIMON &JOHNSON MICHAEL HOVLAND J C RICHARDS CONST CO INC SIMON &JOHNSON
HERB SIMON&THEODORE HOVLAND ARCHITECTS,LTD JCRICCCO42L6 (3/21/09) HERB SIMON&THEODORE
JOHNSON 900 MERIDIAN AVE E SUITE 408 2411 SW 307TH ST JOHNSON
1019 PACIFIC AVE S SUITE 1119 MILTON WA 98354 FEDERAL WAY WA 98023 1019 PACIFIC AVE S SUITE 1119
TACOMA WA 98402 TACOMA WA 98402 —�
Census Category: 437- Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
OccuRancy Load: \
Floor Area(sq. ft.) 0 0 0 0
Additional Permit Information
Existing Sprinkler System in Building? No Mechanical to be Included? No
Number of Stories 1 Permit for Building Shell Only? No
Plumbing to be Included? Yes New/Additional Sq.Feet-Total 0
Zoning Designation Op
Plumbing Fixtures
Drinking Fountains 1 Other Plumbing Fixtures 1 Sinks
CONDITIONS:
SUBJECT TO FIELD INSPECTION �+
PERMIT EXPIRES Monday, July 20, 2009
Permit Issued on Friday, July 20, 2007
•
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 City of Federal Way.
Owner or agent:
Date: 01`,69'��
City of federal Way 40 4110
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: WASHINGTON STATE LOTTERY OFFICE Permit#: 07-104039-00-CO
Address: 33701 9TH AVE S
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load: 0
Floor Area(sq.ft.) 0 0
Owner Name: HERB SIMON&THEODORE JOHNS(
Owner Address: 1019 PACIFIC AVE S SUITE 1119
TACOMA WA 98402
)1/0°.' Date
Buil•mg Officia
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. ��
Et-
.
s r, +
ty of Federal
ah
mm n 'tyDevelopment ay
CotServices
Bul ding - Commercial Perm#: 07-104039- -
P.O.Box 9718 0 0 O
Federal Way,WA 98063-9718
Ph:(253)835-2607 Fax:(253)835-2609. : .:.4 Inspection Request Line: (253)835-3050
Project Name: WASHINGTON STATE LOTTERY OFFICE
Project Address: 33701 9TH AVE S Parcel Number: 926480 0190
Project Description: TI-Interior modifications for new tenant including partition walls and one additional
break room sink. Mechanical work on separate permit.
Owner Applicant Contractor Lender
SIMON &JOHNSON MICHAEL HOVLAND J C RICHARDS CONST CO INC SIMON &JOHNSON
HERB SIMON&THEODORE HOVLAND ARCHITECTS,LTD JCRICCCO42L6 (3/21/09) HERB SIMON&THEODORE
JOHNSON 900 MERIDIAN AVE E SUITE 408 2411 SW 307TH ST JOHNSON
1019 PACIFIC AVE S SUITE 1119 MILTON WA 98354 FEDERAL WAY WA 98023 1019 PACIFIC AVE S SUITE 1119
TACOMA WA 98402 TACOMA WA 98402
Census Category: 437- Commercial alt/add/conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
Additional relit Information kation
Existing Sprinkler System in Building? No Mechanical to be Included No
Number of Stories 1 Permit for Building Shell Only? No
Plumbing to be Included? Yes New/Additional Sq.Feet-Total 0
Zoning Designation OP
Plumbing Fixtures
Sinks
CONDITIONS:_
SUBJECT TO FIELD INSPECTION
PERMIT EXPIRES Monday, July 20, 2009
Permit Issued on Friday, July 20, 2007
I hereby certify that the above i formation is correct and that the construction on the above described property and
the occupancy and the use Fill be in accordance with t e la ules and regulations of the State of Washington
an. w Ci►7•f F der, Way.
Owner or agent: � /1 Date: 2/ J
CL
City of Federal Way 4
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: WASHINGTON STATE LOTTERY OFFICE Permit#: 07-104039-00-CO
Address: 33701 9TH AVE S
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
Owner Name: HERB SIMON&THEODORE JOHNS(
Owner Address: 1019 PACIFIC AVE S SUITE 1119
TACOMA WA 98402
40(/
/ :mil• ng 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.
-
THIS CARD IS TO WAIN ON-SITE
-CITY OF' -+A.
Oommuni Development Inspection Record-
. tY p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT#: 07-104039-00-CO
Owner: HERB SIMON & THEODORE JOHNSON
Address: 33701 9TH AVE S
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.
0 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 Byy. LJ Dateg ...,i1.o7
ElSlab/Concrete Floor(4255) •❑ Underfloor Framing (4285) P LiFloor Sheathing(4105)
Approved to place concrete Approved to sheath floor Approved to install flooring
By Date By Date By Date
❑ Rough Plumbing(4230) ❑ Fire/Draft Stops (4095) NOTE Prior to scheduling a Framing(4120)
Approved A Approved inspection;Electrical,Plumbing&Mechanical
pp Rough-in and Fire/Draft Stop inspections must be
signed-off and approved. IBC 109.3.4/UBC 108.5.4
B .Date c . ' 4.q By Date
, ❑Framing(4120) . ❑ Insulation(4150) * ❑Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
B`y 63 Date 4. i i sin By Date By G Date C .Z
,❑ Suspended Ceiling Grid (4265) ❑ Final-Fire Department(4060) ❑ nal-Planning(4070)
Approved to drop tile Approved Approved
By % Date i Ii p , s132_4e1Date/k.1 .c7 , By Date
•
1
.❑ Final-Plumbing (4075) > ❑ Final-Building(4050)
Approved Approved
By/7'.
Date ll-- 7.4-7 By ...- J Date/f-1
ate/f .s7 .p7
For inspector reference only_
0 Rough Electrical 0 FINAL-Electrical
Approved Approved
By Date By Date
' O''''',4,
� RECEID 0 y 03 9'
All-
Federal Way PERMIT 1,41
COMMUNITY DEVELOPMENT SERVICES J U L 2 0 2007 r/ SF MF CO E E 40 0 E EN FP
33325 3ril RAL AVENUE SO9•PO
BOX 9 718
2FE53DE
-835-26W0A7•YAXWA2538-8359718 O AggLICATION
www.ctgoflrderalwatato-m` i� EDE
'
,iBUILDINGDEPT,
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type.
• PROPERTY INFORMATION
SITE ADDRESS 33 101 / .,Nv 'C e p Mrl'* SUITE/UNIT#
G
ASSESSOR'S TAX/PARCEL# 1. 2 Ce 1 C)°- ° r q 0 LOT SIZE(sJ)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1)
(Attach separate page for lengthy legal descrlptbr)
MI PROJECT INFORMATION
TYPE OF PERMIT ji<BUILDING A PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this rmit onl
4
TLr+Ar i to . — P?-�i,'11 uv, ,.s� (' ru4) s- t
PROJECT NAME(Name of Business or Owner Last Name) W6S0 i.4 4TC 1 SJ7 % (-4:4 j N1 f
• PEOPLE INFORMATION
PROPERTY NAME
PRIMARY PHONE
OWNER /106 sI M - - t , ( W "W. ( ) -
MAILING ADDRESS 11 CITY,STATE,ZIP E-MAIL ADDRESS
VV 19.0. 0w 2 f Z) PIc,►/u&/ 7, ` e I
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
C.' fiale. OS ( ) -
MAI.ING ADDRESS CITY,STATE,ZIP CELL PHONE
5411 s w '3 allL, /r, 2lx. 2.4"45Z3 ( ) -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATJb N DATE FAX NUMBER
( )
COPY r.td
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
with each application (=> &..*"
c I L G c>4 n+L G
APPLICANT COMPANY NAME 4APPLICANT NAME OFFICE PHONE
M•HWLAAaO f /dam iifiver MI /*VGA 0-63 )X37 - ?-46:,,
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
(253 ) 431 - t915
RE 1IONSHIP TO PROJECT FAX NUMBER
PROJECTPRIMARY hitect 0 Tenant ❑Agent 0 Other (25 y) e - II 0I
CONTACT (`{ 1 C fr ,L 1-4,,,L-42.4•3 0 ( Q jJ)PHONE Y7 - ell.5- E-MAIL ADDRESS
LENDER NAME 1•••' r•�7 ell �6(61 VIOL t
Per RCW 19.27.095: Ceart<a 'r•Mk•
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CDT,STATE,ZIP PHONE
( ) -
�yp�, • DETAILED BUILDING INFORMATION
9
EXISTING USE Ir 'CI' CCO%rtfit 0i.47-'64YtY) PROPOSED USE aft �p
EXISTING ASSES?/APPRAISED VALUE$ VALUE OF PROPOSED WORK $ II:t 6/1'
SPRINELERED BUILDING? 0 YES )NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? 0 YES ,6i0
WATER SERVICE PROVIDER 'g(LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER $LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESC' ) 'N EXISTING PROPOSED TOTAL
i SQ.FT. SQ.FT. SQ.FT.
)
BASEMENT
FIRST ' O/25ci
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR 0 UNCOVERED?)
GARAGE 0 CARPORT 0
NUMBER OF FLOORS A T°L TOTAL EXISTING SIF TOTAL PROPOSED SF TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
IN FIXTURES
Indicate number of each type offu-tare to be Installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED W1TFI 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
DUCIb GAS LOG SES REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom Sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS i 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 filed 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. 411 Or
NAME/TITLE / MI Gl fiAr:. f—� . HoNt..AMO. DATE ‘4./2 Dl1
ignature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner/ gent ❑ Contractor 4;4chitect ❑ Other
FOR OFFICE USE ONLY
o NEW ❑ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? ❑YES ❑NO UP/SEPA/SU? 0 YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100—April 2,2007 Page 2 of 4 k\Ilandouts\Permit Application