14-103485 • F 1 •u•ilding - Single Family
City of Federal Way Permit 14-103485-00-S F
Community&Econ.Dev.Services #:
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax:(253)835-2609 Inspection Request Line: (253)835-3050
Project Name: GRG,LLC
Project Address: 2014 S 280TH PL Parcel Number: 422231 0450
Project Description: Inspection of fire damage.
Owner Applicant Contractor Lender,
GRG,LLC MILLER CONSTRUCTION 19 LLC
26821 SE 22ND CT 4105 254TH AVE NE
SAMMAMISH WA 98075 REDMOND WA 98053
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 Il
PERMIT EXPIRES Sunday, January 11, 2015
Permit Issued on Tuesday, July 15, 2014
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
f9rfathe City of Federal Way.
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Owner or agent: / --- i f Date: 7'
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DEPARTMENT OF COMMUNITY DEVELOPMENT S RVICES
33325 8th Aven e South
CITY OF
PO cox 9718
Federal \I1ayFederal Way 980.3-9718
253-835-2607;Fax
253-8t 5-2609
www.cit offederal 'a .com
INCIDENT DAMAGE CHECKLIST
Case# 14 - t0 S 49'c— 00 - Cc--.
Owner's Name: C.,tom, , 1....4....-C,, Phone: 1"'-‘ 14 _
Date of Incident: 1.,1 I IA Date of Inspection: 1 C' 1 1 4
Site Address: 244 > • 1.-'O T';+ P t CI t r .
Nature of Incident/Scope of Damage: ;v't, DA im&ci C \K S(X C4-I 0 n
(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 Q'NOT POSTED
Permits Required:
,„01UILDING ,,L7FPLUI)BING ;®'MECHANICAL LECTRICAL ,,r❑IDEMOLITION
Plans Required: 171/Yes ElNo Plans to Show: `1tr.ti� P (t V c V? a } ,-,�a rr 4`1
C ^ c.
viI i , ✓{ rkttL=Cv44,44 ,h *,vC i, •tet/w%tre) (1 v ".'U
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r
Engineering Required: 'Y
0/Yeses ❑No Specifically: 1.�U✓V?L'1',U v' ( - ✓ 6,vv k- Va)n '
Demolition Complete: El Yes Cl No C N/A 2' Inspection Required: El Yes ❑No
Permit Application Information Provided to Applicant:
❑Demolition Permit Application ❑Building Permit Application
❑.Submittal Checklist ❑Electrical Permit Application
❑Other
tM G-!~f 11,,,lit Or-c.v-1,v f �`'` ,�� , (253) 835- 2,6' .;
Inspector Phone Number
**APPLICANT: PLEASE BRING THIS FORM TO THE CITY WHEN APPLYING FOR PERMITS**
•
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cm(OF 1 �;�
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IIII
PERMIT APPLICATION
Federal Wayti
CITY OF FEDERAL WAY 171'
CDS
PERMIT NUMBER "/ _ ,5 i� ' ��_
f..._....______s__._D
L y / � UU TARGET DATE
SITE ADDRESS SUITE/UNIT#
201'! S i 2BOtiN (Iliressx04 oc , voiv - gt 3
PROJECT VALUATION ZONING ASSESSO S AX/PARCEL#
$ \3, - _
TYPE OF PERMIT *BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVbNTION
NAME OF PROJECT
PROJECT DESCRIPTIONhot) I
Detailed description of work to ,f d Knoloon 4troC,,1jy7 J
be included this permit only , 1
lra ?.,cc.} , 10. 2x ' , ( m$k 1 Y2dv �r�,mr S►I 1 Y0 wl e
. -trro.sey O-c€ix \n �u Clk�ik� r k.\tk, 1 ks:,�d1 FiN••r-
NAM PRIMARY' PHONE
PROPERTY OWNER LLC., 'Zap- 22(j2- g/O(_W
MAILING ADD ESS E-MAIL
11A2.1 se 22roi Ck. ,---
CITY STATE ZIP
Samm0.. YitC) rN1h 960-16
NAME PHONE
m*tx C aNCk - \Ckc -3-5S-gOCpCJ
'MAILING ADDRESS, E-MAIL I
CONTRACTOR 4tOc 254N^ Pe, NE lfrt��err c S'�c tm.`ej czyvi
CITY AST,`ATE ZIP FAX
R�,__(.r4 W� el(/".�-»-41
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
rae o 143L us / /
NAMJY PRIMARY PHONE
*)l\ ci \4 '114-(e1S—S1Q`Etz?
APPLICANT MAILING ADDRESS E-MAIL
lQq SE ' u c A ,2h 3(A rn&Q\.kcc1nc >ctrin
3T� 2IP
ilIMMVk
NAME
sok M�tD ' vLlQfCVYUCvY� PRIMARY PHONE
PROJECT CONTACT `20(p- 33S--ti( (pt(
(The individual to receive and MAILING ADDRESS -e E-MAIL `,` /� `}
respond to all correspondence 41j%Y 25tiiiA Mb �y \tv(�1 tic VIASvvi lrtl jC_ rain'w'
concerning this application) STATE ZIP FAX VI
Mc cl€SOS-2)
NAME
PROJECT FINANCING 104 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27 095)
i
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 complyith
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand thaithe
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws reguliZting
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 de',rise of such claim), which may be made by any person,including the undersigned,and filed against the city,
but only where such c •im arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t• the city as a part of this application.
SIGNATURE: / rd_ 'j DATE 1'1S ' 14.
PRINT NAME: , +kt tk\\tr -
Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application