15-100636 •
Y11166. r •
CITY OF PERMIT APPLICATION
Federal Way RECEIVED `3
/7241
FEB 10 2015
PERMIT NUMBER f 5 _ 1 O 0 Co 3 ( — TARGET DATE CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
J7 � f - r P P4'.5 J` l �'/`Itt .1/ / 7 ` .,
$ PROJECT VALUATION ZONING ASSESSOR' TAX/PARCEL#
33 1 � 0 - ct (7 3ci
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL ❑ DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT Mme(P - A r� h t(C
PROJECT DESCRIPTION r 1, �/
Detailed description of work to tire. ��( 0Qe 0 6.,i011/7 / 7/) ones 7 /75; /
be included on this permit only
N E PRIMARY PHONE
PROPERTY OWNER p1 pal �,ird %a6_E . 6C113
MAILING ADDR .�E-MAIL
626 I
CIT } STATE\ ZIP
PHONE
NAME V VW lI(_'�/`V , "'_t/ 11 .7-077—y`JOL—
CONTRACTOR MAILING ADD I�Q�.i ` r716-75
�7 IL'/l/5 LL j 1% �,►stMt7-16U1I (C�(y„ -.
CITY I MTh° j,�/ STATP Z g FAX
WA ST&TE_CONTRACTOR'S LICENSE � EXPIRATION DATE� FEDERAL WAY BUSINESS LICENSE#
Dr�JJ-H/J S 9 I
N""y-r-,. PRIMARY PHONE
it71 Pah kie-ni
APPLICANT MAILI /IV- /�b E-MAIL
CITY /j-soy ATE_ ZIP��0 FAX
NAME rib" PRIMARY PHONE
PROJECT CONTACT 1M* M V b"
(The individual to receive and MAILIN ADDRESS E-MAIL
respond to all correspondence _
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING /VP
[] OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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 defens• :f such claim), which may be made by any person,including the undersigned,and filed against the city,
but only where such clai arises ou • the/ ianc. of the city, including its officers and employees, upon the accuracy of the
information supplied to e cit as a .• of t, - .pp'cation.
SIGNATURE:U 4 / 14/0;1:1"
DATE ..,?....1dx)5-----
PV,TNT NAME: 1 , 0• ,)
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• 411 r
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
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 {--) 11 DSltb er��1) )
BOILERS FURNACES '' HOT WATER TANKS(Gas)1 •
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMIAIlNp, PERT
Indicate how many of edch type of fixture to be installe r 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 SHOWF,R yACUUMBR00I�Sd1
DRINKING FOUNTAINS kc 11— ITERIhlIATEnh + —
c)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
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?
❑Yes ❑ No ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT -�
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin 11100-January 1,2013 Page 2 of 3 k:\Handouts\Permit Application
• _ r
• ` ' Illilding - Single'Family
City of Federal Way
Community&Econ.Dev.Services Permit #: 15-100636-00-m F
33325 8th Ave S
Federal Way,WA 98003
Inspection Request Line:
Ph:(253)835-2807 Fax:(253)835-2809 p Q (253)835-3050
FII...E
Project Name: MARIPOSA APARTMENTS-UNITS 72,75,76
Project Address: 1711 S 281ST PL Parcel Number: 332204 9039
Project Description: REP-Inspection of fire damage. ***NO construction work approved under this permit***
Owner Applicant Contractor Lender
ALAN R BAILEY DAHLSTROM BUILDERS LLC DAHLSTROM BUILDERS LLC
30127 10TH AVE S 9792 EDMONDS WAY SUITE 196 DAHLSBL925K3(5/23/16)
FEDERAL WAY WA 98003 EDMONDS WA 98020 9792 EDMONDS WAY SUITE 196
EDMONDS WA 98020
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 l►
CONDITIONS:
Fire damage to unit 76.Water damage to adjacent units 67,68,72&75
PERMIT EXPIRES Sunday, August 9, 2015
Permit Issued on Tuesday, February 10, 2015
I hereby certify that the above inf. ation is • Ct and that the construction on the above described property and
the occupancy and the use , ' •• in acco - -nce with the laws, rules and regulations of the State of Washington
nd t City of Federal Way.
Owner or agent: Date: ,Z//06 O /77 1
ttIO
*141‘
• THIS CARD IS TO MAIN ON-SITE r
Construction In ection Record
Federal Way INSPECTION REQ TS: (253)835-3050
PERMIT#: 15-100636-00-MF Address: 1711 S 281ST PL
Project: ALAN R BAILEY 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.
El Final-Building(4050)
Approved /
By t/4/?j Date ( � I I S'
El Rough ElectricalEl Final Electrical El Right of Way
Approved Approved Approved
By Date By Date By Date
• •
41/4 DEPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8th Avenue South
CITY OF " `. PO Box 9718
Federa I Jt1!a , Federal Way WA 98063-9718
253-835-2607;Fax 253-835-2609
www.cityoffederalway.com
INCIDENT DAMAGE CHECKLIST
Case# 15- 100 (0,3(0- oo -c P
Owner's Name: (A la►1 (2-• $et i(Yl Phone:
Date of Incident: NIA Date of Inspection: id
1 Ik I r
Site Address: 117 l 1 <• 2$ ( 5r PL . LAv ik'S 7i 1 7 ) .
_fit.Nature
Nature of Incident/Scope of Damage: �"k✓'G 1) "^-4 - AD +141.1t4- 011c!i v i 2 uk 4
ketitCt 4- S yetI✓e-s ,
(If the value of the damage is greater than 75 percent of the assessed value of the structure, a site plan is required.)
Building Posted:
❑No OCCUPANCY ❑ DANGEROUS BUILDING ❑OTHER I VOT POSTED
Perris ecJ< /
BUILDING L!J PLUMBING rYtECHANICAL NfELECTRICAL ❑ DEMOLITION
Plans Required: gJSYes ❑No Plans to Show: g U4 +t.t"t i v101lAl VC(Ole. G.TLb&u.Vill wall iset • Dr 11100 4t Lt,(,,„4 6'yet c.
Engineering Required: 4/Yes ❑No Specifically:
Demolition Complete: ❑ Yes ❑No IN/A 2"d Inspection Required: ❑ Yes 1:4
Permit Application Information Provided to Applicant:
❑Demolition Permit Application ❑Building Permit Application
❑ Submittal Checklist ❑Electrical Permit Application
❑Other
(AA&-+t- 13e-ch-e4.- (253) 835- '141'L3
Inspector Phone Number
**APPLICANT: PLEASE BRING THIS FORM TO THE CITY WHEN APPLYING FOR PERMITS**