11-102358City of Federal Way Wilding - Single Family
Community Development Services Permit #: 11 -1 02358 -00 -SF
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: 253 835-3050
Ph: (253) 835-2607 Fax (253) 835-2609 P q ( )
Project Name: BLOOMQUIST
Project Address: 30124 17TH AVE SW Parcel Number: 005070 0120
Project Description: ADD - Construct patio cover over existing 187sgft deck
Owner
Armlicant
Contractor
Lender
ROGER R BLOOMQUIST
TEDFORD CONTRACTING
TEDFORD CONTRACTING
30124 17TH AVE SW
SERVICES
SERVICES
FEDERAL WAY WA 98023-3453
PO BOX 730
TEDFOCS962NE (8/5/12)
BLACK DIAMOND WA 98010
PO BOX 730
BLACK DIAMOND WA 98010
Census Category: 434 - Residential altladd - no change in number of units
Includes: # 1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft.) 0 0 0 0
CONDITIONS:
Subject to field inspection with plans.
PERMIT EXPIRES Monday, December 12, 2011
Permit Issued on Wednesday, June 15, 2011
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: /
3' '4&Crry OF
Federal Way
PERNUT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction I>ection Record s
INSPECTION REQ TS: (253) 835-3050
11 -102358 -00 -SF Address: 30124 17TH AVE SW
ROGER R BLOOMQUIST FEDERAL WAY, WA 98023-3453
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.
r]
SWM Precon Site Mtg (4400)
E:]
Initial Erosion Control (4365)
❑
Footings/Setback (41 10)
Approved
By
To be done prior to breaking ground
Approved to place concrete
By
Date
By
Date
By
Date
0 Gypsum Wallboard Nailing (4130)
Approved to install mud & tape
By Date
Final Erosion Control (4375)
Approved
By Date
® Final - Building (4050)
Approved
By Date Vt
Foundation Wall (4115)
E:]
Drainage/Downspout (4040)
❑
Slab/Concrete Floor (4255)
Approved to place concrete
By
Approved to backfill
Approved to place concrete
By
Date
By
Date
By
Date
❑
Floor Sheathing (4105)
Shear Walls (4245)
Underfloor Framing (4285)
Approved to sheath floor
Approved to install flooring
Approved to install siding
By
Date
By
Date
By
Date
Roof Sheathing (4220)
Fire/Draft Stops (4095)
Interim Erosion Control (4370)
Approved to install roofing
Approved
Approved
B
Date
By
Date
By
Date
Prior to scheduling a Framing inspection;
Framing (4120)
Insulation (4150)
Electrical,
Plumbing & Mechanical Rough -in and
Approved to insulate
Approved to install wallboard
Fire/Draft Stop inspections must be signed -off and
approved. IBC 109.3.4
/
8J l� Date ��
By
Date
0 Gypsum Wallboard Nailing (4130)
Approved to install mud & tape
By Date
Final Erosion Control (4375)
Approved
By Date
® Final - Building (4050)
Approved
By Date Vt
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
I F
.o,,
Federal Way
COMMUAM DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
www. dt,gofjedeml way. cam
•PERMIT
APPLICATION
I L--10
(*MF CO E PL E EN FP
[DECEIVED
1. n. -A C my
SITE ADDRESS MINI INI S
�c' 8 Z. 'i- �Z� Amt S ,w gab s �� , E®ERAL WAY
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL @ ;S®S
11
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
�\ -,N
O ®V C)� e
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
2e] 51 qk- 11\0 �� � �
PRffiARY PHONE
��� _ ��- C-\
MAILING AD REBS
'10 \ Z S -1-7 V
E-MAIL
CITY
ZIP
p g$ y
®eS®TAppTE
NAME
G ADDRESS
�
E-MAIL
CONTRACTOR
®
9 xCITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE @
Wn"RATION DATE
FEDERAL WAY BUSINESS LICENSE 0
NAME
PHONE ~� _
APPLICANT
MAILING ADDRESS
Q U
EMAIL
• Q"5
CITY
31,
STATE
ZIP
FAX
PROJECT CONTACT
NAME
"ONE
(The individual to receive and
eat A•• _ --
r.
ADDRESS� _ ®%
770
E-MAIL
respond to all correspondence
concerning this application)
1
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E MAII.
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $5,000 or more
MAEUNG 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 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.
SIGNATURE: s` %, ,sem-� DATE B'
rJ s
PRINT NAME: PAl Q.sTd Z.71-
Bulletin #100 — January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
VALUE OFMECHAATICAL WORK IF (a copy of bid or estimate must be provided)
Indicate how many qf each We of re to be installed or relocated as part of this project. Do not inclu xisting res to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (c
BOILERS FURNACES HOT W TANKS (Gas)
COMPRESSORS GAS LOG SETS R3PfffGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be in or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/sh.-"Combo)3
(xsuash,�
TOILETS
WATER PIPING
DISHWASHERS�NS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINSSHOWERS
�I W
VACUUM BREAKERS
DRINKING F
SINKS (xftcb=/UtuM
WATER HEATERS (meati)
EXUr=G/PREVIOUS USE
vC� ��'
BS
SUMPS
WASHING MACHINES
?�.'n.l
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF X313MG EXPROVEMENTS
Yeo
(,U(�
BUD$
�I W
EXUr=G/PREVIOUS USE
vC� ��'
LOT SIZE (in Square Feet)
3 I
E]QSMG FIRE 8PRThI�,E SYSTEM?
❑ Yes �No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes a-1 T --
l
Bulletin #100 — January 1, 2011 Page 2 of 3 k:\Handouts\Perinit Application