10-101823Cl* of Federal Way 0
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718 FILE
Ph: (253) 835-2607 Fax: (253) 835-2609
. Building - Commercial
Permit #: 10 -101823 -00 -CO
Project Name: NORTHSHORE VILLAGE LANDLORD WORK
Project Address: 35509 21ST AVE SW
Inspection Request Line: (253) 835-3050
Parcel Number: 252103 9002
Project Description: TI - Soft Demo to remove bar,1 office,1 kitchen, 2 baths, prep for new layout
Owner
Annlicant
Contractor
Lender
DAVID HOEK
DAVID HOEK
DAVID's FEDERAL WAY LLC
DAVID HOEK
DAVID's FEDERAL WAY LLC
DAVID's FEDERAL WAY LLC
PO BOX 8164
DAVID's FEDERAL WAY LLC
PO BOX 8164
PO BOX 8164
TACOMA WA 98418
PO BOX 8164
TACOMA WA 98418
TACOMA WA 98418
TACOMA WA 98418
Census Category: 437 - Commercial alt / add / conversion
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft. 0 0 1 0 1 0
PERMIT EXPIRES Sunday, October 31, 2010
Permit Issued on Tuesday, May 4, 2010
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
nd t e Cl of Federal Way.
r _
Owner or agent: 1 �"' Date: g ' `f -/0
CITY OF 4�
Federal Way
• THIS CARD IS TO ON-SITE
Construction In ction Record
INSPECTION REQ TS: (253) 835-3050
PERMIT #: 10 -101823 -00 -CO Address: 35509 21 ST AVE SW
Owner: DAVID HOEK FEDERAL WAY, WA
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.
SWM Precon Site Mtg (4400)
❑
Initial Erosion Control (4365)
Final Electrical
Approved
Footings/Setback (4110)
1:1Approved
Approved
By
To be done prior to breaking ground
Approved to place concrete
By
Date
By
Date
By
Date
Re -steel (4215)
❑
Slab/Concrete Floor (4255)
Final Electrical
Approved
Underfloor Framing (4285)
1:1Approved
Approved to place concrete or grout
By
Approved to place concrete
Approved to sheath floor
By
Date
By
Date
By
Date
Floor Sheathing (4105)
Fire/Draft Stops (4095)Interim
Erosion Control (4370)
Approved to install flooring
Approved
Approved
By
Date
By
Date
By
Date
13
Framing (4120)
Prior to scheduling a Framing inspection;
❑
Insulation (4150)
Electrical, Plumbing &Mechanical Rough -in and
Approved to insulate
Approved to install wallboard
Fire/Draft Stop inspections must be signed -off and
By
Date
By
Date
approved. IBC 109.3.4
Gypsum Wallboard Nailing (4130)
❑
Suspended Ceiling Grid (4265)
Final - Fire Department (4060)
Approved to install mud & tape
Approved to drop tile
Approved
By
Date
By
Date
By
Date
Final Erosion Control (4375)
Final - Building (4050)
Approved
Approved
By
Date
By
j� Date
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
449ERMIT
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Federal Way
COhDNUMTV DEVELOPMENTS5E P p L I CATION
25.',-R.35-2607• FAX 25.3-R.3S-2 9 ,
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SITE ADDRESSSUITE/UNIT
C;�'J
IqJ s(
#
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL N
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL
DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(tenant Name/Homeowner Last Name)
j
PROJECT DESCRIPTION
Detailed description of workto
t iw�vt bad a 1Z� e.►-�
a V Ia/A
be included on this permit only
PROPERTY OWNER
NADH�—� -1
o S I-edteG✓ �C
PRDIARY PHONE
0106 _G?5 _Y� 4 r
MAILING ADDRESS ��� 77 ?
E DIAIL
CITY
STATE
ZIP �2
NADA
PHONE
SAILING ADDRESS -
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
-
WA STATE CONTRACTOR'S LICENSE ►
EXPIRATION DATE
FEDERAL WAY RUSUIESS LICENSE A
NAME W / � t�
PHONE
MAD,mG ADDRESS
E DEAD.
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
respond to all correspondence
SIAD.ING ADDRESS
E-MAIL
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NnDE
OWNER -FINANCED
Required value of $5, 000 or more
MAILING ADDRESS, CITY, STATE, Z13P
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 ir4f'ormation 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 filled 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 tot city as rt of this application.
SIGNATURE: D" " "` 1 �Y' DATE 1 v
PRINT NAME: Url l Q /T : lyyt-y-
Bulletin #100 -April 14, 2010 Page 1 of 3 k:\Handouts\Pennit Application