12-101226City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
i r
Building - Single. Family
Permit #: 12 -101226 -00 -SF
Inspection Request Line: (253) 835-3050
Project Name: CHARWOOD MOBILE HOME PARK SPACE 4
Project Address: 1660 S 333RD ST Space 4 Parcel Number: 797880 0081
Project Description: NEW - Install 950 square feet double wide mobile home.
Owner
ARRlican
Contractor
Lender
CHARWOOD PARK LLC
AMERICAN HOME CENTER
HORSLEY S MOBILE HOME
6619 132ND AVE NE PMB 254
16311 MERIDIAN E
SERVICE
KIRKLAND, WA 98033-8627
PUYALLUP WA 98375
HORSLMHO74DC (3/23/14)
PO BOX 764
PUYALLUP WA 98371
Census Category: 112 - New Manufactured/Factory-Built Home, IN PARK
Includes: #1 #2 #3 #4
Occupancy Class: R-3
Construction Type:
Occupancy Load-
Floor
oadFloor Areas . ft. 950 0 0 0
Additional Permit Information
New / Additional Sq. Feet - 1 st Floor....................0 New / Additional Sq. Feet - 2nd Floor ................... 0
New / Additional Sq. Feet - 3rd Floor....................0 Occupancy # 1 - Area (Sq. Feet) ............................. 950
New / Additional Sq. Feet - Basement...................0 New / Additional Sq. Feet - Deck .......................... 0
New / Additional Sq. Feet - Garage.......................0 Occupancy #I - Class............................................. R-3
New / Additional Sq. Feet - Other..........................0 New / Additional Sq. Feet - Total.......................... 0
Occupancy # 1 - Use ............................................... Residence (1 or 2
family)
No Fixtures Associated With This Permit It
PERMIT EXPIRES Saturday, September 22, 2012
Permit Issued on Monday, March 26, 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
and the City of Federal Way. ll ,l �,
Owner or agent: �i�/' � opDate: -3 '—Cg(; &Ie—
City of Federal Way
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: CHARWOOD MOBILE HOME PARK SPACE 4 Permit #: 12 -101226 -00 -SF
Address: 1660 S 333RD ST Space4
Includes: #1 #2 #3 #4
Occupancy Class. R-3
Construction Type:
Occupancy Load
Floor Area (sq. ft.) 950 0 1 0 0
Owner Name: CHARWOOD PARK LLC
Owner Address: 6619 132ND AVE NE PMB 254
KIRKLAND, WA 98033-8627
Building 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.
CITY OF
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 835-3050
12 -101226 -00 -SF Address: 1660 S 333RD ST Space 4
Project: CHARWOOD PARK LLC FEDERAL WAY, WA 98003-6434
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.
BlockinWTie Downs (4015)
Approved
By j4 Date
Final Erosion Control (4375)
Approved
By Date
0 Skirting/Final (4250)
Approved
By Date
SWM Precon Site Mtg (4400)
Initial Erosion Control (4365)
0
Interim Erosion Control (4370)
Approved
By
To be done prior to breaking ground
Approved
By
Date
By
Date
By
Date
BlockinWTie Downs (4015)
Approved
By j4 Date
Final Erosion Control (4375)
Approved
By Date
0 Skirting/Final (4250)
Approved
By Date
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
OF
V:�k� Federal Way
Building Division
33325 Eighth Avenue South
Federal Way, WA 98003-6325
Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: 10 (o i� � , '1113FT ST, 5pVK Y PERMIT#:
"0�__rA !!;rAt L ftJC_t rLS TD T- SCA1-1 /i -S l'aZ PLASS • llri M,<
Af e7- Ajn c%D -fy SKw
IF YOU HAVE QUESTIONS CALL ff%tl8r�16D (253) 835- o
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE -INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
q- 24 -FcF
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page t of
ED
v *PERMIT MF CO ME PL DE EN FP
Y
COMMUNITYDEVELOPM�[ ,C� 2012
{2 APPLICATION
253-835-2607• FAX 2 609
un��w.dtro eria_rafu�a•ont FEDERAL
���
CITY n FED_
SITE ADDRESSSUITE/UNIT#
Loo 6o. 335�cQ s
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
v
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL
DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/HomeownerLast Name)
C,/I P—wevb mor `/ !i—
v (�
PROJECT DESCRIPTION
s/Y��% v tJ-
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
C g�W
PRIMARY PHONE
4 0-3 — 9L05
MAILING ADDRESS
/,(e 0;' 3�3R� ST, /3—
E-MAIL
fjq+ewo c',4.yr i
CI �.�j
viz
STATE
ZIP
NAME
PHONE
6 �V
MAILING ADDRESS f
E-MAIL
CONTRACTOR
` } ,
Lk) A -t
111101 111111 (i
ITY
STATE/
Z <
(4"1
FAX
WDA ^STATE CONTRACCTOWS LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE#
V -,,�
ME
N � � � I�
PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAME
PHONE j� Q
MAILING ADDRESS
1446> 5Q'
E-MAIL
C!7
ST�AATE
i
ZI�J n
FAX
ALTERNATE CONTACT NAME: t
PHONE
E-MAIL
PROJECT FINANCING
NAME
®/WNER-FINANCED
Required value of $5, 000 or more
(RCW 19.27.095)
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 apart of this application
�j
y
SIGNATURE: G� ,v,"�jifO DATE
PRINT NAME:
Bulletin #100 — January 1, 2011 Page] of 3 k:\Handouts\Permit Application
t
VALUE OFMECRAMCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type 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 r�HER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial) --
BOILERS NACES HOT WAA R-3'ACVKS (cas)
COMPRESSORS GAS SETS R–E00DSERAT ON SYST
DUCTING GAS PIPIN /W
Indicate how many of each type of fixture to bei ailed or relocated as part of t ect. Do not include existing fixtures to remain.
BATHTUBS (or Tub/shower Combo)`S (H—dSink.) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitchen/utility) WATER HEATERS (Electric)
HOSE BIBBS SUMPS WASHING MACHINES
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
sem,- �a'< 7
ESTIMATED SELLING PRICE # OF
BEDROOMS
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application
Contractors or Tradespeople Prir r Friendly Page
I'I General/Specialty Contractor
Page 1 of 2
A business registered as a construction contractor with I -Ed to perform construction work within the scope
of its specialty. A General or Specialty construction Contractor must maintain a surety bond or assignment
of account and carry general liability insurance.
IBusiness and Licensing Information
Name
HORSLEY'S MOBILE HOME SRVC INC UBI No.
601395077
Phone
2538415696
Status
Active
Address
Po Box 764
License No.
HORSLMHO74DC
Suite/Apt.
2
License Type
Construction Contractor
City
Puyallup
HORSLEY'S MOBILE
State
WA
CExpirationDate
3/23/2014
Zip
98371
te
ow
HOME SERVICE
County
Pierce
Specia y
nufactured/Mobile Home Set -Up
Business Type
Corporation
Specialty 2
Unused
Parent Company
Until
Bond
Insurance Co
Other Associated Licenses
License
Name
Type
Specialty 1
Specialty
Effective
Expiration
Status
Received
Account Number
Date
Date
2
Date
Date
Date
HORSLMH120C3
HORSLEY'S MOBILE
Construction
Mobile Home
Siding
2/23/1988
2/23/1993
Archived
HOME SERVICE
Contractor
Set -Up
States
01ci31462930
03/03/2012
03/03/2013
Business Owner Information
Name I Role
I Effective Date
Expiration Date
HORSLEY, FRED THOMAS jPresident
101/01/1980
Impaired
Bond Information No records found for the previous 6 year period
Assignment of Savings Information
Savings
Assignment of Savings
Effective
Release
Assignment
Impaired
Amount
Received
Received
Account Number
Date
Date
Type
Date
Date
Date
2
6450930
2/28/2002
Until
Bond
$6,000.00
3/1/2002
Released
States
01ci31462930
03/03/2012
03/03/2013
1
64509OR
3/2/1993
Until
Bond
Insurance Co
$4,000.00
3/1/2002
Released
American
Insurance Information
Insurance
Company
Policy
Effective
Expiration
Cancel
Impaired
Amount
Received
Name
Number
Date
Date
Date
Date
Date
American
12
States
01ci31462930
03/03/2012
03/03/2013
$500,000.0002/08/2012
Insurance Co
American
11
States
01C13146291
03/03/2011
03/03/2012
$500,000.0002/24/2011
Insurance Co
AMERICAN
https://fortress.wa.gov/Ini/bbip/Print.aspx 3/23/2012
1660 S. 333- ST. #15, FEDERAL WAY, MfA 98003
PHONE 253-$3$-9606
E-MAIL Charwooda@davisinvestors.com
March 23, 2012
Federal Way Building Department;
Pursuant to FWRC #19.95.060 B
Charwood Mobile Home Park removed an RV from this space on March 20th 2012 and set them up in
another space. This was done so we could move in the Mobile Home on this lot. If you have any
questions feel free to contact me by either phone or e-mail.
Sincerely,
Bill & Katie
Managers
MAS
CITY C)F FEDERAL WAY
CUSS