04-101158 . RECEIVED
un of G • BUILDING DIVISION
MAR 1 7 2005 33530 First Way South/P.O.Box 9718
VV AY Federal Way,WA 98063
lTY OF FEDERAL WT. (253)661-4000/Fax(253)661-4129
INCIDENT DAMAGE CHECKLISTBuILDIIVG DEPT'
CASE #04- to U s Q)--VO
DATE OF INCIDENT: S –a S- O4 DATE OF INSPECTION: –
SITE ADDRESS: .3Z 301 2ND )
Nature1of Incident/Scope Of Damage: F N -Da7 �� y„iR',�2r tt
-C)l� I I -E,55 De L/.r i i L� / `s�,i i �A M.c�!(/•
1.Q.c."-r:c.. I I-J.1• ti,1,41 k.1et 744,SS 4-.2 Yr./
N•cQ(etc ciA4e2itiwles�- ac
(If value of damage is greater than 75% of assessed value of structure, a site plan is required)
Buil g Posted: � �
NO OCCUPANCY IL�'DANGEROUS BUILDING 0 OTHER 0 NOT POSTED
Permits Required: �' ��
BUILDING ID-PLUMBING lalI CHANICAL L5"ELECTRICAL 0 DEMOLITION
Plans Required: grfis 0 No// Plans to show: R. ,,,
�4r,� , t.�t�- r„ss.eS
[04� r`elGo.INeva
fr •trl'T5
Engineering Required:1 I�'�`Yes 0 No Specifically:Csy-
r-L�lit wl std_1 1 r0 SSe S
Demolition Complete: 0 Yes Co 0 N/A
2nd Inspection Required: 0 Yes
Permit Application Information Provided To Applicant:
❑ 12..e.molition Permit Application
uilding Permit Application
O Submittal Checklist
—'fectrical Permit Application
❑ Other
S-914— ' -�� (253) 661-41 S�
Spector Phone Number
**APPLICANT. PLEASE BRING THIS FORM TO THE CITY WHEN APPLYING FOR PERMITS**