00-105283 III •
City of Federal Way
Cormnmiity Development Services Building - Single Family Permit #:00 - 105283 - 00 - SF
33530 1Way, Inspection request 98003-6210 s
Federal line: 253.6, 4140
Ph:253.661.4000 Fax:253.661.4129
(3:30pm cut-off for next day i • .ections)
Project Name: VYBORNY
Project Address: 4234 SW 328TH ST Parcel Numb : 87 i 1 0400
Project Description: RES REP-Tear off shakes,resheet,reroof with comp
Owner Applicant Contractor 0 Lender
Gayle L&Andrea L Vyborny NONE ADKINS ROOF INC P '.'E
4234 SW 328TH ST 0
FEDERAL WAY WA 4008 227TH AV: r
98023-2629 NONE BUCKLEY WA 98 NONE
Includes:
Census category: 555-Non-st #1 #3 #4
Occupancy Group: R-3 g_
Construction Type: Type V-N
Occupancy Load:
Floor Area(Sq.Ft.):
•
Census Category 555-Non-struc ral roofing p .a' al No
Occupancy Group#1 R-3 'lu '. ng No
PE . ' T ' I C. , ,ril 21,20 1, NO WORK IS STARTED.
SPe on ,2000
Aiip
I hereby certify that the above information is c• ec . u .t the n on the above described property and
the occupancy and the use will be in accordance the laws le d regulations of the State of Washington and
the City of Federal Way.
Owner or agent: 3 n e40/. 10
Date: /D/
041.
i
PO'HIS CARD ON THE FRONT OF BUILD. •
��F epE1ZAL BUILDING DIVISION
VV FiY INSPECTION RECORD
INSPECTION REQUEST PHONE#: 253-661-4140
Request must be received by 3:30 PM for next day inspection
PERMIT #: 00-105283-00-SF
OWNER'S NAME: Gayle L & Andrea L Vyborny
SITE ADDRESS: 4234 SW 328TH
() FOOTINGS/SETBACKS () FOUNDATION WALL
DO NOT POUR CONCRETE UNTIL THE ABOVE IS APPROVED
( ) DRAINAGE: Line ( ) Connection
DO NOT POUR SLAB UNTIL THE ABOVE IS APPROVED
( ) UNDERFLOOR FRAMING
() ROUGH PLUMBING: DWV Water piping
( ) ROUGH MECHANICAL Gas piping
( ) SHEATHING Roof 6 d- Floor
( ) SHEAR WALLS %y 55
() ELECTRICAL ROUGH-IN Ditch Cover
( ) EIRE/DRAFTSTOPS
ALL THE ABOVE MUST BE APPROVED PRIOR TO FRAMING INSPECTION
( ) FRAMING/FIRESTOPPING
THE.ABOVE MUST BE APPROVED PRIOR TO INSULATING OR SHEETROCKING
( ) INSULATION: Floors Walls Attic
THE ABOVE MUST BE APPROVED PRIOR TO APPLYING SHEETROCK
() WALLBOARD NAILING () SUSPENDED CEILING
THE ABOVE MUST BE APPROVED PRIOR TO TAPING OR INSTALLING CEILING TILE
() ELECTRICAL FINAL
( ) PLANNING FINAL
() PUBLIC WORKS FINAL
( ) FIRE FINAL
THE ABOVE MUST BE APPROVED PRIOR TO BUILDING DEPARTMENT FINAL
() BUILDING FINAL
DO NOT OCCUPY THIS BUILDING UNTIL BUILDING FINAL IS APPROVED
si91 ��_ &6/� 47/,2 CONS-MUG-ION N PERMIT APPLICATION
�� l- »� ,,..,• ,VPD APPLICATION NUMBER: _ _ - -OS `'ti -JF
FTY
APPLICATION NUMBER: _ _ - - - -
- -
OCT 2 3 200t1 APPLICATION NUMBER: -
**The_1Fplllpygjng is req ji information-Please print(in ink)or type**
Please note: Electrical, Fire Prevention Sysi-ems and Engineering permits may require a separate application.
■ PROPERTY INFORMATION
SITE ADDRESS: ui�37 (,et-, z--. )'S\� hi ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
�/ ■ PROTECT INFORMATION
TYPE OF PROJECT(This application): L�BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description): ;'e 2 G,� , ,Z(/.e_-(;, /IBJ G'QL L7 /ZQ�cJ /,�3
, ,
PROJECT NAME:
- - ■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: DAYTIME PHONE:
6756 0&lffiy
MAILING DD SS(STRDDRESSTATE,ZIP):
x/33 V S&) ,t'
1135
CONTRACTOR: NAME: ih /5 UC/ , DAYTIME PHONE:
I�-1 WY �_ c l )/ (Zj )2.i -3.3ys
MAILING ADDRESS(STREET ADORE CITY STATE,ZIP): EVENING PHONE:
)
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER: FAX NUMBER:
- -
CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE:
a 1.)_ & " - Ke // / 33 / CO
APPLICANT: NAME: DAYTIME PHONE:
1/n /7d/C,n s S;33 ) %'/ 33'(j
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE:
lAitis ,__ ___ -/`' 04-4, <'iz 7-- f vuC&.,, _‘(4 94:D/ (53 ) ,,,.2 -505
RELATIONSHIP TO PROJECT: '
FAX NUMBER:
CI ARCHITECT ❑ TENANT [ OTHER(DESCRIBE): el yQ.�. ( )
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER ❑ APPLICANT Ll CONTRACTOR
■ DETAILED BUILDING INFORMATION .
EXISTING USE: Y��`?ri e:, I ll,cjL EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: a? PROPOSED VALUATION FOR IMPROVEMENTS: $ Li OC 0
SPRINKLERED BUILDING? ❑ YES NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:❑ YES ❑ NO
WATER SERVICE PROVIDER: KEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER: J24AKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
,. '1 2,0(lc
**NEW RESIDENTIAL CONSTRIDON ONLY**
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
• PROTECT FLOOR AREAS • •
•
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■. FIXTURES .
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC ❑ GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) ❑ ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
. ' • 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,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the city
as a part of this application.
NAME/TITLE: � � }� i )\j4jQVLADATE: %t/�9J/�
❑ PROPERTY OWNER ❑ APPLICANT I9'CONTRACTOR
FOROFFICE USE ONLY: I
afl iNEW ❑.ADDITION ;U ALTERATION EPAIR ❑ . MANT IMPROVEMENT '
CENSUS CODE: ..OTSIZE : .
ZONING`bESIGNATION• ' 5BUILDING SHELL ONLY? CI YES NO
COMP PLAN'DESIGNATION' - BASIG 1N? 0 YES NO
SECTION , TOWNSHIP RANGE NEW ADDRESS REQUIRED?' _; :_0 YES 0 NO
PLATTED LOT? ❑ YES Cl NO CHANGE OF USE? : ❑YES O
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•P.O.BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
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