12-105308 *?_-_—_ 1 0 5- 0 RP-'
arrOF j:kECEIVEDOpERMIT
Federal Wa MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVI :®V 21 20A p p L I C AT I O N dtl
253-835-2607•FAX 253-835-2609 _1
WIMP ri fkriernh?ay.egT /
CITY OF FEDERAL WAY Ol
— CDS
,SITE ADDRESS SUITE/UNIT#
2 f 4,2 t 20`o 04/41 s r6.0 e A4 . WX//1t y s kPvitf roiNP fil 6
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4- Z 2.- Z 91 1 - 0 o c o
TYPE OF PERMIT .BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) k2tijactind a „ J,
PROJECT DESCRIPTION -42)- ,, (Z;LLAi
40167-°-)
w2 ),Q. :.(fL.1/
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ti C(.I e 4 4 e S/OEM/ T/it 4.
MAILING ADDRESS p E-MAIL
Ztl wectS 'teed S . K 100
CITY STATE ZIP
Redio •✓ IJ,q 16O 7
NAME PHONE
MAILING ADDRESSE-MAIL
CONTRACTOR _
CITY _.-------- STATE ZIP FAX
SIR CO 4'S i R ti Cr f0✓ WA TE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME ,Q _ PHONE ...
CS,BL3�@- JI U4 /
APPLICANT MAILING ADDRESS E-MAIL
/4 76-I A/ ledl.56y Sr, sre ioSi.01S6/
CITY STATE ZIP FAX
1`lo�R0a _ tem 18272 .
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
AI,IINNTACT NAME: PHONE E-MAIL
-
-PROJECT FINANCINGNAME OWNER-FINANCED
Required value of$5,000 or more _
(RCW 19.27.095) MAILING ADDRESS ,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.
,LLL.SIGNATURE: ' ij D �'�- DATE ' Z ' i Z O I Z
PRINT NAME: CSA 8 4' V /t Q 4 i✓
Bulletin#100-January I,2011 Page I of 3 k:\Handouts\Permit Application
•
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 GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS. . FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
'•Ss...a.:, ,<.. ..•.� ...�a.�.,,:�,�,�� -�, , ,;- • ti .. �,. .. €.>s,.. '.�,. ,. . , �'.�`'•
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.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Eieruie)
HOSE BIBBS SUMPS WASHING MACHINES ;y _.Tt31AI.I er
A
til °`
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
I3 Yes ❑ No • ❑Yes ❑ No
.•a. n� -a xm... �..," a
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
.. •.�. :��. .$_..,.a.t...:n....5.....e,.a;:itu.n_....wuwlc..:.a.....�.'vct..:<.....,,...E.c. cic. .� ,X.,�„d..� .,..��. _.._._
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE 0 CARPORT 0
- °- :A, is ,,
�3r.a�,� ��dv,..;�aa' 4 �;�.,.Rz•.�. ''�'----- -------------.—... _..___.._...--'--”--_
EXISTING PROPOSED TOTAL
Area Totals
r : gra •
i.,..�.a „._�..,z �'�a`aor..¢,�a.:`<`"�...,Ms rM��.ss"^.:r ., �: _,.s.,,✓x�.s�r15- �.. «,rfa�_'s-.' .`�:u: ..a,,. ...r u...�...,,.�a,.z�" as'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in S,uare Feet • ,e Stories
`: ,.. ._.�a' s,- ».,sa:;,., <,,>,..r,:a.,, . „ ..<„a.,,,..�.,_,.v..� .Nt�,e..az��t::,
ADDITION
Iti
AREA DESCRIPTIONPLIVERI Occupancy Group(s) Construction St ries Additional Information
•P "�;3' d"'Y R '1 6���` C•'
".:.. � E.. a:
TENANT AREA ONLY
e �� �w�a,^•�, F s v s�ear .� a4*° �' i C�. �. = f �g,� S � � � �`-S F` �;;<. ,z, .flr,� .�1`,^`
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application
t
• ilding - Single Family
City of Federal ay
Community&Econ.Dev.Services Permit #: 12-105308-00-SF
33325 8th Ave S
Federal Way,WA 98003 ._>: ,,_ Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p Q
Project Name: LAURELWOOD GARDEN APARTMENTS
Project Address: 29422 21ST PL S Parcel Number: 422291 0020
Project Description: REP-Inspection of fire damage. **NO construction work approved under this permit**
Owner Applicant Contractor Lender
KING COUNTY HOUSING S I R CONSTRUCTION S I R CONSTRUCTION
15455 65TH AVE S 14751 N KELSEY ST SUITE 105 SIRCO**0660T(3/19/14)
SEATTLE W 98188 MONROE WA 98272 14751 N KELSEY ST SUITE 105
-
MONROE WA 98272
Census Category: 434-Residential alt/add-no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load
Floor Area(sq.ft.) 0 0 0 0
Additional Permit Information
New/Additional Sq.Feet-3rd Floor 0 New/Additional Sq.Feet-Basement 0
Mechanical to be Included? No Plumbing to be Included? No
No Fixtures Associated With This permit!!
PERMIT EXPIRES Monday, May 20, 2013
Permit Issued on Wednesday, November 21, 2012
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
(�
� ��an��d the City of Federal Way.
Owner or agent: �Q4La d Date: 1(/2/(1 0 l L
r
Pt
4. I ,
y _
1Z/&/12-
THIS CARD IS TO IN ON-SITE
CITY OF Construction In ection Record
Federal Way INSPECTION REQUE TS: (253)835-3050
PERMIT#: 12-105308-00-SF Address: 29422 21ST PL S
Project: KING COUNTY HOUSING FEDERAL WAY, WA 98003
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.
A Final-Building(4050)
Approved
"?
B.Ak101011111r Date (Z., (- / _/
0 Rough Electrical El Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date