16-104485City of Federal Way'
Community & Econ. Dev. Services
33325 8th Ave S r
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Building - Single Family
Permit #: 16-104485--OO-SF
Project Name: DOROTHY LEWIS REVOCABLE LIVING TRUST
Project Address: 28220 28TH AVE S
Inspection Request Line: (253) 835-3050
Parcel Number: 111700 0190
Project Description: REP - Tear off existing roofing; install OSB sheathing and composition shingle roofing
system.
Owner
Aonlicant
Contractor
Lender
DOROTHY LEWIS REVOCABLE
JAMES E TEDRICK
TEDRICICS ROOFING INC
LIVING TRUST
TEDRICK'S ROOFING INC
TEDRIRI121NC (5/14/17)
28220 28TH AVE S
. 37220188TH AVE SE
37220 188TH AVE SE
FEDERAL WAY WA 98003
AUBURN WA 98092-8909
AUBURN WA 98092
Census Category: 555 - Non-structural roo n ermi s'
Includes.
# 1 #2 #4
Occupancy Class:
R-3 * r�
Construction T
Type V - B
Occupancy Load
Floor Areas . ft.
-"0
0 J 0 0 0
�il'l Permit tion
New /Additional Sq. Feet - Fly or...... 0 ,; ` /Additional Sq. Feet -Basement ......
Calculated Structure Valuation.. .. 5495.00 Occupancy #I - Construction Type............
Mechanical to be Included?............. No Occupancy #I - Class .................................
........:......
Plumbing to be Included? .............. , .,::...........No _ % Occupancy # 1 -Use ...................................
No Fixtlures-I1'oc'lated With This Permit !1
407
I
MIT EXPIRES Wednesday, March 8, 2017
Permit Issued on Friday, September 9, 2016
.......0
......TypeV-B
.......R-3
....... Residence (1 or 2
family)
herebyr�dbrtify that the above information is correct an that the construction on the above described property and
the o, upancy and the us ill be in accordan the laws, rules and regulations of the State of Washington
,��"'` th ity of r I Way.
Cnr F
Federat by
PERMIT #:
Project:
THIS CARD IS TO REMAIN ON-SITE
Construction Inspection Record
INSPECTION REQUESTS: (253) 83530M
16 -104485 -00 -SF Address: 28220 28TH AVE S
DOROTHY LEWIS REVOCABLE LIQ FEDERAL WAY, WA 98003-3309
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
Roof Sheathing ( anal - Building )
Approved to install roofing Approved
By AO Date 'yjjZ-11b IlBy Date
Rough Electrical
Approved
0
Final Electrical
Approved
0.
Right of Way
Approved
By
Date
By
Date
By
Date
CITY Or
Federal Way
RECEIVED
A 9 2016 PERMIMPPLICATION
CITY OF FEDERAL WAY
PERMIT NUMBER V _ 1 () �° S
TARGET DATE
SITE ADDRESS
SUITE/UNIT •
PROJECT VALUATION
$L.5
ZONING
ASSESSOR'S TAS/PARCEL i
TYPE OF PERMIT
11-44UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
. f
r
PROJECT DESCRIPTION�7
Detailed descriptionof work to
`
^/%
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILDY ADDRESS O A
EMAIL
CITY STATE
PHO
MAILING ADD 0
'Z
E_Mim
CONTRACTOR
CITYSTATE
woft
FAX
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE i
WA ST TE CONTRACTOR'S LICENSE N
ij
s�
NAME,—,-�`
,
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME /
PRIMARY PHONE
MAILING ADDRESS
(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 Iaws.
cluding costs, expenses, and attorneys' fees incurred in
I further agree to hold harmless the City of Federal Way as to any �.V�on,
the investigation and defense such claim), tay be m aincluding the undersigned, and filed against the city,
but only where such claim see out a reli city, i is officers and employees, upon the accuracy of the
information supplied to t city as a rt of thi piicatt
SIGNA DATE
PRI N
I�
Bulletin #100 — January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application