11-103883City of Federal Way Ifuilding Single FdmiJy
Community Development Services Permit #. 11 -103883 -00 -SF
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: 253
Ph: (253) 835-2607 Fax: (253) 835-2609 p q ) 835-3050
Project Name: WIEBE a06
Project Address: 30308 17TH AVE SW
Parcel Number: 005070 0170
Project Description: ALT - Tearing off cedar shakes, resheeting and installing new asphalt roof system.
Owner
Applicant
Contracto
Lender
CAMERON J WIEBE
JORNADA ROOFING
JORNADA ROOFING
CAMERON J WIEBE
VALERIE A WIEBE
PO BOX 1992
JORNAR1943CC (2/11/12)
30308 17TH AVE SW
30308 17TH AVE SW
AUBURN WA 98071
PO BOX 1992
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
AUBURN WA 98071
Census Category: 555 - Non-structural roofing permits
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft. 0 0 0 0
New / Additional Sq. Feet - 3rd Floor....................0 New / Additional Sq. Feet - Basement ................... 0
Mechanical to be Included?....................................No Plumbing to be Included? ....................................... No
.i a
PERMIT EXPIRES Saturday, March 24, 2012
Permit Issued on Monday, September 26, 2011
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: '04-t- - U CLA--- Date: 9'� � ( I
NO 1014111
Cff
44i"&
Federal Way
PERMIT #:
11 -103883 -00 -SF
THIS CARD IS TO EMAW ON-SITE
Construction I ection Record
INSPECTION REQU TS: (253) 835-3050
Address: 30308 17TH AVE SW
Project: CAMERON J WIEBE FEDERAL WAY, WA 98023-3452
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.
E] Roof Sheathing (4220)Final - Building (4UM)
Approved to install roofing Approved
ByJ CS Dat —�� I. l By Date 110 /Q — �—%r
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
. f►
C,n°rPERMIT
Feder I ���
COMMUNITY DEVE
253-835-2607• FAX 253-835-2609 APPLICATION
www. dtuoffederalwaLom
SEP 2 6
�nIAV
4MF CO ME PL DE EN FP
SITE ADDRESS oC CE
305 6 I tr� I�tJt� s1�7
SUITE/UNITM
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL 8
$ l b ,'(OO . cc
— — — — — — - — — — —
TYPE OF PERMIT
/� BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
l a v�C cT W- � ✓'�-�� '
Detailed description of work to
(=
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
caog
E-MAIL
CITY
Fe,� w
STATE
wh
ZIP
NAME
J o��.o-ei.a :� o� 1 'i....t�
PHONE
ZS 3 • tis 8 to'Z
MAMING ADDRESS
P 0 �oX 1 92
E -MAH.
1
CONTRACTOR
CITYSTATET,0190-71
A�6v�h
I�JJc
IP
FAX
213.735. la3�t LP
WA STATE CONTRACTOR'S LICENSE 6
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE N
CCS
/ t / 'L
oft.
NAME
r'�..,� ad�h ✓tasoR
PHONE
7S_3 •453- 28(el
MAILING ADDRESS
E -MAH.
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
MAiLUM ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME.
PHONE
E-MAII.
PROJECT FINANCING
El 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 defense of such chine), 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: &4 7. UcG U ' DATE
PRINT NAME: /,e►vr16vl otita �-3 �u^" 1%` (S �1�w1..
Bulletin #100 -January 1, 2011 Pagel of 3 k:\Handouts\Permit Application
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