16-102955City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: NIKSICH
Project Address: 1141 SW 352ND ST
Building - SingleFamily
Permit #: 16-102955-00=SF
Inspection Request Line: (253) 835-3050
Parcel Number: 5028601470
Project Description: REP - Remove existing shake roofing and install new OSB plywood with composition
shingles.
Owner
ARRlicant
Contractor
Lender
KELLI NIKSICH
CASS ROBB
LEGENDS ROOFING CO INC
1141 SW 352ND ST
LEGENDS ROOFING CO INC
LEGENRC984DN (3/15/14)
FEDERAL WAY WA 98023
PO BOX 731249
PO BOX 731249
PUYALLUP WA 98373
PUYALLUP WA 98373
Census Category: 555 - Non-structural roofing permits
Includes:
#1 #2 #3 #4
Occupancy Class:
R-3 IL
Construction T
Type V - B
Occupancy Load
Floor Areas . ft.
0 0
Ac
New / Additional Sq. Feet - 3rd Floor....................0
Calculated Structure Valuation ..................... ... %10
Mechanical to be Included? ...........................
Plumbing to be Included?..................%L ........ t
*4
Aor
of on
Additional Sq. Feet - Basement...................0
upancy # 1 - Construction Type ........................Type V - B
Occupancy # 1 - Class.............................................R-3
Occupancy # 1 -Use ............................................... Residence (1 or 2
family)
This Permit 11
RES Wednesday, December 14, 2016
t Issued on Friday, June 17, 2016
fat the abov information is correct and that the construction on the above described property and
nd the use 701;accordance with the laws, rules and regulations of the State of Washington
and the City of Federal Way. -% z %
Date:��--J!'
THIS CARD IS TO REMAIN ON-SITE
cilhr os W
Fir Construction Inspection Record
Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 16 -102955 -00 -SF Address: 1141 SW 352ND ST
Project: KELLI NIKSICH FEDERAL WAY, WA 98023-6921
Scheduled inspections may be failed if this card is not on-site. n0 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
❑ ID Approved to nstall roofing ❑ Approved
Building
By A40 vete 4 / 20 ///. I By Date
❑
Rough Electrical
Approved
11Final
Electrical
Approved
1:1Right
of Way
Approved
By
Date
By
Date
By
Date
40k
CITY OF
Federal Way
PERMIT NUMBER ) G
RECEIVED
J 017 2015
PERMIT*.PPLICATION
CITY OF FEDERAL WAY
Z
CDs
0 b
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ to `� y
- - - - - -
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
j I� �n
PROJECT DESCRIPTION
� ,
Detailed description of work to
n w CoT� a i
be included on this permit only
PROPERTY OWNER
NAM
PRIMARY PHONE
MAILING ADDRESS
11W i S, •
E-MAIL
STATE
ZIP
FAME GM
I `
PaS3 -Sys--31 q �-
ING ADDRESS
47 Ly
E-MAIL
CONTRACTOR
ti 1A V
STATE
ZIP
9�3� 3
FAX
WAS ATE CONT CTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
L Al
NAM
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
N
CSS S
RDIQARY PHONE
� 3��-3oS
MAILING ADDRESS
EMAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME :L0
OWNER-FINANCED
When value is $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 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 ut oft reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city apart this application.
SIGNATURE: DATE
PRINT NAME: ''1 S
Bulletin #100 — February 22, 2016 Page 1 of 2 k:\I-Iandouts\Permit Application