05-102545 e . 0
City of
unity Federal Way Building - Single Family Permit #: 05 - 102545 - 00 - SF
Community Development Services
P.O.Box 9718
Federal Way,WA 98063-9718
Ph:(253)835-7000 Fax:(253)835-2609 Inspection request line: (253) 835-3050
Project Name: MIDWAY SAMOAN CHURCH
Project Address: 29276 MILITARY RD S Parcel Number:042104 9063
Project Description: REP-Structurally reinforce a remodelled single-story residence by installing collar tie system. No
plumbing or mechanical work included.
Owner Applicant Contractor Lender
MIDWAY SAMOAN ASSEMBLY 01 THE NISHIMURA ASSOCIATES*Tt MIDWAY SAMOAN ASSEMBLY 01 MIDWAY SAMOAN ASSEMBLY O]
29276 MILITARY RD S 12737 BEL-RED RD SUITE 220 29276 MILITARY RD S
FEDERAL WAY WA BELLEVUE WA 98005 29276 MILITARY RD S FEDERAL WAY WA
98003-7916-- FEDERAL WAY WA 98003-7916
Includes:
Census category: 434-Reside #1 #2 #3 #4
Occupancy Group R-3 11
Construction Type Type V-B iL
Occupancy Load
Floor Area(Sq.Ft.): 1378 -T 1
Building Pre-con.Meeting Required No Census Category 434-Residential alt/add-no
Fire Sprinklers No Mechanical No
Number of Stories 1 Permit for Building Shell Only No
Plumbing No Special Inspection Required No
Will Certificate of Occupancy be Issued? No Sensitive Areas? Yes
Zoning Designation RM 3600
PERMIT EXPIRES January 10,2006.
Permit issued on July 14,2005
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. fi
Owner or agent: )71, ,{ Date: .� (�,1 t/�t Zapt
lithit, ' • THIS CARD IS TO•MAIN ON-SITE ' •
GTYOF ! ommunitSiDevelo ment Ins ection Record
p p
Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050
PERMIT #: 05-102545-00-SF
Owner:
Address: 29276 MILITARY RD S
FEDERAL WAY, WA 98003-7916
This card is part of your required inspection documents. 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.
0 Temp. Erosion Control (4365) ❑ Plumbing Groundwork(4190) 0 Underfloor Framing(4285)
To be done prior to breaking ground Approved to cover Approved to sheath floor
By Date By Date By Date
Floor Sheathing(4105) Shear Walls (4245) Roof Sheathing
❑ 0 0 (4220)
Approved to install flooring Approved to install siding Approved to install roofing
By Date By Date By Date
Fire/Draft Stops (4095) NOTE: Prior to scheduling a Framing(4120) ❑ Framing (4120)
Approved inspection;Electrical,Plumbing&Mechanical Approved to insulate
L
Rough-in and Fire/Draft Stop inspections must be
signed-off and approved. IBC 109.3.4/UBC 108.5.4
By Date By Date
,
O Insulation (4150) 0 Gypsum Wallboard Nailing(4130) 0 Final- SWM(4375)
Approved to install wallboard Approved to install mud&tape Approved
By Date By Date By Date
.❑ Final-Building(4050) ['Temp. Erosion Maintenance(4370)
Approved Approved
`By� .J Date... —By Date
mow
RECEIVED 11vi 13
•
cma�' �` JUN p 1 2005 il c_
Federal Way PERM �� ��-��
ITS FE "IMF E EL PL DE EN FP
COMFed
Federal
SERVICES f� r33325 8T"AVENUE SOUTH•PO BOX 9718QEPT.FEDERAL WAY,WA 98063-9718 APPLICATION .. —
253trww.607•FAX 253-835-2609 / / �
uwu�.ci(yo((ederah��n4.rnm t� [),—
The ollowin• is re•uired in ormation-an incom•lete a••lication will not be acce•ted. Please • 'nt le•ibl_ (in ink)or _
"
j,-if�/ • PROPERTY INFORMATION f
SITE ADDRESS 2 7 �; X- Ak,l i ri j W. SUITE/UNIT# kik
ASSESSOR'S TAX/PARCEL# 0 /-1- 1- 4- - 11 0 LOT SIZE(s,, ),t 4--
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) 5 7.-2-0 r� ix Ni I:* Y/k-PT sit Ac.- o f potz. S W '14. OF NV 114, i-(ui OF
(At•h `nn po9e tyfe e Br Ierrgthy legal, descript'.n)
k e bill L.....6:
SS toz A • EW MC-N ,f jt ,• y i2.0
■ PROJECT INFORMATION
TYPE OF PERMIT (` 9?tt(/ 'BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide deta'-. description of work incblda.,on is .ermit onl
C Y; ' v ./ t' A re 1100' • 0 ^ • - ,ry ri - `( eti
/ ' ' .t`n ' 0, " A /11'44 4 4 Al 4 NE • •
PROJECT NAME(Name of Business or Owner Last Name) +►t l S a1 t't mv. s 1'v)L6 kO-4-
• PEOPLE INFORMATION J
PROPERTY NAME }��/� , PRIMARY PHONEQq --f
OWNER M,lG+4,� UJ �( ri{ /�a7C/�� 141,�� bf &( (7-15-;) E,I -9817
MAILING ADDRESS `J CITY S ATE.Z P
1127b S /1n.►i(W �� e e re. VAla.l, WAr- 110°
CONTRACTOR COMPANY NAME ' APPLICANT NAME OFFICE PHONE
k !"
cAlu cpe it'S OKI a r Dr ( ) -
MAILING ADDRESS CITY.STATE,ZIP CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
/ / ( )
B L
CONTRACTOR'S REGISTRATION NUMBER(copy of card required with each application) EXPIRATION DATE
/ /
APPLICANT COMPANY N E APP CANT N OFFICE PHONE
-fine NimAttlt kr oCt'C $ -‘04kisiAtmark. ( '2 ) -; - 4-aL
MAILING ADDRESS CITY,S ATE,ZIP CELL PHONE
X211 1 R W4 1 R..e4eVite, vi - gybb5 (2vb) to -7,32
RELATIONSHIP TO PROJECT ^ FAX NUMBER
❑Architect ❑ Tenant 0 Agent )(Other(Describe) /1/)(XML r
(L 2.4 ) (4 C L - LlLb g q
CONTACT is (w,otiY^A-
N � � PRIMARY PHONE
(L1Z .) 1-F•3 Lt8?io 7,-MAIL ADDRESS
arvq- etto �lootvVII
LENDERPer RCW.19.27.095: Lender information is NAME _
required i'f project value exceeds$5,000
C. (5 Fj L� �j( Zf y(
MAILING ADDRESS CITY.STATE,ZIP
• DETAILED BUILDING INFORMATION
EXISTING USE 9-414-aj f p t)0 PROPOSED USE J A-
EXISTING ASSESSED/APPRAISED VALUE $ 11-; )77C 0 VALUE OF PROPOSED WORK $ ifoO''
SPRINKLERED BUILDING? C YES . i NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES C NO
WATER SERVICE PROVIDER Ti(LAKEHAVEN C HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER , LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
i 15
.E
IIIM
•
PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED
TOTAL
BASEMENT sq. FT. SQ.FT. .SQ.FT.
FIRST ryrik
I�I,
SECOND I :7 1g( 117j7 f5
THIRD IA X/titA-
y NIA
FOURTH X/ NIA
14 ii--
ADDITIONAL FLOORS(DESCRIBE) ,er Ni
,r NIA „sr iA
DECK(COVERED?) LJ� 1�t
1 I,, P e
GARAGE ❑ CARPORT❑
g NI
NUMBER OF FLOORS I >snsTrn° I P1OPO8� TOTAL rorec [A
MISTING OF 70TAL8P
**NEW HOMES ONLY** NUMBER OF BEDROOMS NIA ESTIMATED SELLING PRICE $ i.2)/e>
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS LOGS
BBQS FANS REFRIG.SYSTEMS
HOODS(commercial) WOODSTOVES
BOILERS FIREPLACE INSERTS RANGES
COMPRESSORS MISC(Describe)
FURNACES GAS WATER HEATERS
DUCTS GAS PIPE OUTLETS
PLUMBING
BATHTUBS(or Tub/Shower Combo) SHOWERS WATER CLOSE1S(Toilet) MISC(Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS
RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAVS(Bathroom Sinks) VACUUM BREAKERS ELECTRIC WATER HEATERS
DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 of Federal Way,but only where such claim
arises out of the reliance e city,including its officers and employees,u
this application. pon the accuracy of the information supplied to the city as a part of
t J
NAME/TITLE ,(Ar DATE j, r)5
ignature) (title) J
RELATIONSHIP TO PROJECT G Owner 0 Agent ❑ Contractor n Architect Other Prol ct havtaryAr
FOR OFFICE USE ONLY
NEW n ADDITION n ALTERATION n REPAIR n TENANT IMPROVEMENT
BUILDING SHELL ONLY? n YES ❑NO BASIC PLAN?
ZONING DESIGNATION o YES a NO
CHANGE OF USE? o YES a NO
NEW ADDRESS REQUIRED? a YES a NO UP/SEPA/SU?
o YES a NO
PLATTED LOT?
YES -NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin#100—January 7,2005 Page 2 of 4
k\I-Iandouts\Permit Application