11-103049City of Federal Way #uilding - Single Family
Community Development Services Permit #: 11 -1 03049 -00 -SF
P.O. Box 9718
Federal Way, WA 98063-9718 Inspection Request Line: 2
Ph: (253) 835-2607 Fax: (253) 835-2609 p q (53) 835-3050
Project Name: PINNACLE ADULT FAMILY HOME
Project Address: 33006 28TH AVE SW Parcel Number: 894520 0880
Project Description: ADD - Construct ramp for adult family home
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 42 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft. 0 1 0 1 0 0
Acd�tmiElnformation
New /Additional Sq. Feet - 1 st Floor, 0 New / Additional Sq. Feet - 2nd Floor .... ....... ....... 0
New / Additional Sq. Feet - 3rd Floor....................0
Basic Plan? ......................................... I................... No
New/ Additional Sq. Feet - Garage..':..:................0
New / Additional Sq. Feet -. Other....:....................0
New / Additional Sq. Feet - Total .......................... 0
Ncw / Additional Sq. Feet - Basement ................— 0
New / Additional Sq. Feet - Deck ........................ 0
Mechanical to be Included? .................................. No
Plumbing to be Included?.......................................No
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No Fixture&AaAj lillhh This Permit 1!�
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Tuesday, January 24, 2012
Permit Issued on Thursday, July 28, 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:? Z :; i y ..� Date: %//7•i'�
rm"Lm> 49 /lr/l(
Owner
Applicant
Contractor
Lender
NORMA & NORI BALI
NORMA & NORI BALI
31614 12TH PL SW
31614 12TH PL SW
31614 12TH PL SW
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
FEDERAL WAY WA 98023
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 42 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft. 0 1 0 1 0 0
Acd�tmiElnformation
New /Additional Sq. Feet - 1 st Floor, 0 New / Additional Sq. Feet - 2nd Floor .... ....... ....... 0
New / Additional Sq. Feet - 3rd Floor....................0
Basic Plan? ......................................... I................... No
New/ Additional Sq. Feet - Garage..':..:................0
New / Additional Sq. Feet -. Other....:....................0
New / Additional Sq. Feet - Total .......................... 0
Ncw / Additional Sq. Feet - Basement ................— 0
New / Additional Sq. Feet - Deck ........................ 0
Mechanical to be Included? .................................. No
Plumbing to be Included?.......................................No
SKr g
No Fixture&AaAj lillhh This Permit 1!�
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Tuesday, January 24, 2012
Permit Issued on Thursday, July 28, 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:? Z :; i y ..� Date: %//7•i'�
rm"Lm> 49 /lr/l(
CITY OF
Federal Way
PERMIT #:
11 -103049 -00 -SF
THIS CARD IS TO MAIN ON-SITE'
Construction I ection Record
INSPECTION REQUE TS: (253) 835-3050
Address: 33006 28TH AVE SW
Project: NORMA & NORI BALI FEDERAL WAY, WA 98023-2709
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.
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SWM Precon Site Mtg (4400)
E]
Initial Erosion Control (4365)
❑
Footings/Setback (4110)
Floor (42.55)
Approved
Approved to place concrete
To be done prior to breaking ground
Approved to backfill
Approved to place concrete
By
Date
By
Date
By
Date
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Foundation Wall (4115)
E]
Drainage/Downspout (4040)Slab/Concrete
Final Electrical
Approved
Floor (42.55)
Right of Way
Approved to place concrete
Date
Approved to backfill
By
Date
Approved to place concrete
By
Date
By
Date
By
Date
Underfloor Framing (4285)
Floor Sheathing (4105)
Shear Walls (4245)
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
By
Date
By
Date
By
Date
Prior to scheduling a Framing inspection;
El
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
By
Date
By
Date
approved. 113C 109.3.4
Gypsum Wallboard Nailing (4130)
Final Erosion Control (4375)
Final - Building (4050)
Approved to install mud & tape
Approved
Approved
By
Date
By
Date
By
Date _ 1,1
Rough Electrical
Approved
Final Electrical
Approved
1:1Approved
Right of Way
By
Date
By
Date
By
Date
CITY OF ��:
Federal ECEIVF• PERMIT
COMMUNITY DEVELOPMENT SERVICES A P P L I C A T I O N
253-835-2607• FAX 253-835-26 A
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#
PROJECT VALUATION
ZONING
ASSESSOR'$- AX/PARCEL #
TYPE OF PERMIT
U BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/ Homeowner Last Name)
A// y j`�� a/,; X-
PROJECT DESCRIPTION
Detailed description of work to
�O
be included on this permit only
PROPERTY OWNER
NAME
PRIMARY PHONE
MAILING ADDRESS
E_ -
CITY
STATIC
NAME
PHONE
�i,yZ t
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME'
(16f ( 16f q:e iGv 1
Ip JIONE
1 ' �7i eve%
APPLICANT
MAILING ADDRESS .
E_ L
CITi4 i
STATE
ZIPr
PROJECT CONTACT
NAME
PHONE
(The individual to receive and
MAILING ADDRESS
E-MAIL,
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
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 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 tothe city as apart of this application.
SIGNATURE: i 2 - _ G [.I DATE 7
PRINT NAME:
Bulletin #100 — January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
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