11-103309 City of Federal Way • ilding - Single Family
Community Development Services Permit #: 11-103309-00-SF
P.O.Box 9718
Federal Way,WA 98063-9718 nS
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request F I LEq st Line: (253)835-3050
Project Name: HLASNIK
Project Address: 28301 15TH AVE S Parcel Number: 025130 0190
Project Description: REP-Remove existing cedar shingles and replace with composite asphalt
Owner Anolicant Contractor Lender
JOHN&DOLORES HLASNIK BATES ROOFING LLC BATES ROOFING LLC JOHN&DOLORES HLASNIK
28301 15TH AVE S PO BOX 9416 BATESRL945JO(4/20/12) 28301 15TH AVE S
FEDERAL WAY WA 98003-6100 TACOMA WA 98409 PO BOX 9416 FEDERAL WAY WA 98003-6100
TACOMA WA 98409
Census Category: 555 -Non-structural roofing permits
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. 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
l ,,r � t�'. ice•. .
ed •.
No �c�ctatWith This PerttiI
•
PERMIT EXPIRES Sunday, February 12, 2012
Permit Issued on Tuesday, August 16, 2011
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the u e will be in accordance with the laws, rules and regulations of the State of Washington
and the City ederal Way.
Owner or agent: z� ---;-: Date: -1/
FIftLE3 g I4 /i l
THIS CARD IS T MAIN ON-SITE
r •
CITY OF ' Construction I ection Record
Federal Way INSPECTION REQUE TS: (253) 835-3050
PERMIT#: 11-103309-00-SF Address: 28301 15TH AVE S
Project: JOHN & DOLORES HLASNIK FEDERAL WAY, WA 98003-6100
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.
El SWM Precon Site Mtg(4400) El Initial Erosion Control(4365) El Underfloor Framing(4285)
Approved To be done poor.to breaking ground Approved to sheath floor
By Date By Date By Date
El Floor Sheathing(4105) 0 Shear Walls(4245) 0 Roof Sheathing(4220)
Approved to install flooring Approved to install siding Approved to install roofing
By Date By Date By fLf Date(2y //
O Fire/Draft Stops(4095) ❑ Interim Erosion Control(4370) Prior to scheduling a Framing inspection; 4.
Approved Approved Electrical,Plumbing&Mechanical Rough-in and
Fire/Draft Stop inspections must be signed-off and
By Date By Date approved. IBC 109.3.4
O Framing(4120) CI Insulation (4150) 0 Gypsum Wallboard Nailing(4130)
Approved to insulate Approved to install wallboard Approved to install mud&tape
By Date By Date By Date
O Final Erosion Control (4375) .0 Final-Building(4050)
Approved Approved
By Date , Date 9_ (4_ + 1
O Rough Electrical El Final ElectricalEl Right of Way
Approved Approved Approved
By Date By Date By Date
4101. CITY of A 1 1 - F U .3 J O
' Federal Way PERMITMF CO ME PL DE EN FP
COMMUN7YDEVELOPMENT SERVICES APPLICATION RECEIVED
253-835-2607•FAX 253-835-2609 p
Liam.rifyofederalu�aucoae Q't D
AUG 1 6 2n!i
SITE ADDRESS ;� �, 1� ��� CITY OF I L WAY
•h
f=r•.✓-7r ;'t (.— L-•=irc i . L.\Ji 7-,-' ("Y- 3 CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ /(- , ( /poc, 02-- 5I30 — Qt ' 10
TYPE OF PERMIT 'BUILDING WLY1Y" 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) -�` ,1 T '� T ) /44- �, ,,
}f l LL 't ►T
PROJECT DESCRIPTION
i?....---,-,)�� 1,../(..-: C'.L-+J/1- 1 �7�i'3�'= -
Detailed description ofwork to 1L��,)�_ 1 /
crin f�*_�K.,cam- c 0-/TA /\- ;4/A-1-21-- ( 44V(-t_ L_A-. 1.)/t3 c) •-
be included on this permit only -/H ,A..---
,
NAME
-NAME PRIMARY PHONE
PROPERTY OWNER '!yWI ')(RC2-, fii>7 _,t f,, -9S-'-5-4(,-,-(pov /
MAILING ADDRESS 1� E-MAIL
d ' -'/ IS /4-ct . - < .
CITY STATE ZIP
FL-Ce) --C_(�-c_, v.;/r-f-> L 01) / CO
NAME - r PH
( )p— -� Rc br-7 e,C., C, c C . ?s 3 - c<s j -( S
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE 0 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
NAME ..-_, PHONE
!) 1-- ----J <</'7 f_'ce_ CLL X53--G-c3--( c\•..
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and t (E?..1 i l L(:)-7:5� ' �-
respond to all correspondence MAILIIiG ADDRESS nn E-MAIL
concerning this application) '1>P,---,1) '7�" •fir"S`L'�
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING r NAME OWNER-FINANCED
Required value of$5,000 or more
(-)C .).��
(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 out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this applicatio
1
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SIGNATURE: (--"2"-- il, --'--‘--A...._ ` DATE P --/6, - /)
PRINT NAME: C-<� / N/L4->,JI <—
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application