14-104388City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: INGERSOLL
Project Address: 29849 91111 AVE SW
Building - Single Vamily
Permit #: 14 -104388 -00 -SF
Inspection Request Line: (253) 835-3050
Parcel Number: 195460 0195
Project Description: ALT - Tearing off existing comp roofing and installing new insulated panels and new comp
shingles.
Owner
Applicant
Contractor
Lender
JEFF A INGERSOLL
BERGIN ROOFING INC
BERGIN ROOFING INC
NANCI L INGERSOLL
20815 2ND PL SW
BERGIRI044JA 4/1/16
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29849 9TH AVE SW
NORMANDY PARK WA 98166
20815 2ND PL SW
FEDERAL WAY WA 98023
NORMANDY PARK WA 98166
Census Category: 555 - Non-structural roofing permits
Includes: # 1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load-
Floor
oadFloor Areas . ft. 0 1 0 1 0 1 0
Additional Permit'lnformation
New / Additional Sq. Feet - 3rd Floor....................0
Mechanical to be Included?....................................No
New / Additional Sq. Feet - Basement...................0
Plumbing to be Included?......................................No
No Fixtures Associated With This Permit 11
PERMIT EXPIRES Monday, February 23, 2015
Permit Issued on Wednesday, August 27, 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
and the City of Federal Way.
Owner or agent: Date:
THIS CARD IS TO REMAIN ON-SITE
CITY OF .
Federal Way Construction Inspection Record
y INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 14 -104388 -00 -SF Address: 29849 9TH AVE SW
Project: JEFF A INGERSOLL FEDERAL WAY, WA 98023-8205
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 Roof Sheathing ( 220) 0Final - Building (4050)
Approved to install roofing Approved
B Date � Zj_c !� By Date
Rough Electrical
Approved1:1
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
CITY OF
Federal Way
PERMIT NUMBER _
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PERMIT *PPLICATION
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FITY,O,F, 272014 27—L
FE[S �
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
$ To".rU
ZONING
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ASSESSOR'S TAX/PARCEL #
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TYPE OF PERMIT
k, BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Thr
PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
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NAME
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FEDERAL WAY BUSINESS LICENSE #
NAME III( ,/I '�
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PRIMARY PHONE
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MAILING ADDRESS
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E-MAIL
APPLICANT
CITY .,
STATE
ZIP
FAX
PROJECT CONTACT
NAME
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PRIMAR PHONE
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MAILING ADDRESS
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E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -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.
SIGNATURE:
DATE
PRINT NAME:
Tf h h P h
Bulletin #100 — January 1, 2013 Page I of 3 k:\Handouts\Permit Application