10-105021City of Federal Way
Community Development Services
P.O. Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835.7609
Project Name: SMITH
Project Address: 27919 21ST AVE S
Building - Single Family
FILE Permit #: 10 -105021 -00 -SF
Project Description: ALT - Window replacement.
Inspection Request Line: (253) 835-3050
Parcel Number: 757562 0550
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft.) 0 0 0 0
Additional Permit Information l '.
New/ Additional Sq. Feet - 1 st Floor.... ................
0
New / Additional Sq. Feet - 2nd Floor .... ...............
Contractor
Lender
Owner
New / Additional Sq. Feet - Basement...................0
Basic Plan? ...... .....................................................
DANIEL & ANCHETA SMITH
DANIEL & ANCHETA SMITH
NEIMAN GLASS
DANIEL & ANCHETA SMITH
27919 21ST AVE S
27919 21ST AVE S
NIEMEGC92OPF (9/25/12)
27919 21ST AVE S
FEDERAL WAY WA 98003-6949
FEDERAL WAY WA 98003-6949
34621 16TH AVE S
FEDERAL WAY WA 98003-6949
0
FEDERAL WAY WA 98003
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft.) 0 0 0 0
No Fixtures Associated With This Permit l!
PERMIT EXPIRES Tuesday, May 31, 2011
Permit Issued on Thursday, December 2, 2010
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the us I be in accordance with the laws, rules and regulations of the State of Washington
wand e City of Federal Way.
Owner or agent: Date: ��
-�- ,� 1z/1(*/1CP
Additional Permit Information l '.
New/ Additional Sq. Feet - 1 st Floor.... ................
0
New / Additional Sq. Feet - 2nd Floor .... ...............
0
New/ Additional Sq. Feet - 3rd Floor ....................
0
New / Additional Sq. Feet - Basement...................0
Basic Plan? ...... .....................................................
No
New / Additional Sq. Feet - Deck ..........................
0
New / Additional Sq. Feet - Garage .......................
0
Mechanical to be Included? ....................................
No
New / Additional Sq. Feet - Other ..........................0
Plumbing to be Included? .......................................
No
New / Additional Sq. Feet - Total ..........................
0
No Fixtures Associated With This Permit l!
PERMIT EXPIRES Tuesday, May 31, 2011
Permit Issued on Thursday, December 2, 2010
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and the us I be in accordance with the laws, rules and regulations of the State of Washington
wand e City of Federal Way.
Owner or agent: Date: ��
-�- ,� 1z/1(*/1CP
CITY OF
Federal Way
PERMIT #:
THIS CARD IS TO REMAIN ON-SITE
Construction Ins .,xtion Record
INSPECTION REQUE TS: (253) 835-3050
10 -105021 -00 -SF Address: 27919 21 STAVE S
Project: DANIEL & ANCHETA SMITH FEDERAL WAY, WA 98003-6949
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. .
Final Erosion Control (4375) Final - Building (4050)
Approved Approved
By Date By �� Date
El
E] SWM recon Site Mtg (
El Initial Erosion Control (436
0 Underfloor Framing(4285)
Shear Walls (4245)
E] Roof Sheathing (4220)
Approved
To be done prior to breaking ground
71
Approved to sheath floor
Date
Approved to install siding
By Date
By Date
By Date
By
Final Erosion Control (4375) Final - Building (4050)
Approved Approved
By Date By �� Date
El
Floor Sheathing (4105)
❑
Shear Walls (4245)
E] Roof Sheathing (4220)
Approved to install flooring
By
Date
Approved to install siding
Approved to install roofing
By
Date
By
By
Date
By Date
Interim Erosion Control (4370)
Fire/Draft Stops (4095)
Prior to scheduling a Framing inspection;
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
E] Gypsum Wallboard Nailing (4130)
Insulation (4150)
Framing (4120)
Approved to insulate
Approved to install wallboard
Approved to install mud & tape
By
Date
By
Date
By Date
Final Erosion Control (4375) Final - Building (4050)
Approved Approved
By Date By �� Date
El
Rough Electrical
Approved
Final Electrical
Approved
Right of Way
Approved
By
Date
By
Date
By
Date
DATE
O'
AREA
1
'I-MSPECTION
CevtwECEIV E-�
4 ay vv PERMIT
FederaCOWWITYDEVELOPMENT SERvici tEC U 2 2
AgpLICATION
253-83.5-2607• FAX 253-835-2609
n•imv gigx';y'rimVRrc,i,cr. rr
r,TY OF FEDERAL- WAY
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F CO ME PL DE EN FP
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SITE ADDRESS
SUITE/UNIT #
z�`11q 21 �rf�-vim S, -
PROJECT VALUATION
ZONING
JLi
ASSESSOR'S TAX/PARCEL 8
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Name/Homeowner Last Name)
S M
(Tenant
N DOC—P L A S OAr
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
--
PROPERTY OWNER
NAME
PernJ (t L �, (
PRIMARY PHONE
25-3 L1 6 —9 Oct 6
MAILING ADDRESS
Z�? 10/ 2 15fi gvES r
EMAIL
e1616LV l connca
CITY
-�F(Z4- A y
f
Vv
Wl -
j
ZIP %
A
U
NAME
MEMAN 61. 'y
st
25-3)38 —1813
MAIt.$LG ADDRESS � � �� AVE �
- �/P
E-MAIL/
CONTRACTOR
CITY
6Vc-A AL—. W
STATE
W P,
ZIP
co C) -0
FAX
WA STA COH'[RACTOR'S LICENSE #
V- 691- OFf—i
EXPIRATION DATE
2ri lZ-
FEDERAL WAY BUSINESS LICENSE M
r9—pO 6 — goo 009—
- -
NAME . �O (EJL - .S'r�/liT l l,�
23 ) l 7 6 —G 1 0 1
MAILING ADDRESS
It OtIs i4v'b S_
E-MAIL
F2 WIt 5k CG1 -h
APPLICANT
FAX
_
CITY STATE ZIP
G/�5, A44- W rob)
PROJECT CONTACT
NAMf��
PHONE
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME: PHONE
E-MAIL
PROJECT FINANCING
NAME
N '+
OWNER -FINANCED
Required value of $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 apart of this application. r�
SIGNATURE: DATE
PRINT NAME: !1f _ _ • ' I
Bulletin #100 — April 14, 2010 Page 1 of 3 k:\I-landouts\Penrdt Application
h -it
l'
VALUE OF MECH&MICAL WORE
..6d
(a copy of bid or estimate must be rovided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do n t include existing fxtures to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLE OTHER (Describe) _
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (Commerow
BOILERS
FURNACES
HOT WATER TA KS Ioesl
COMPRESSORS
GAS LOG SETS
REFRIGERAT] N SYST
I DUCTING
GAS PIPING
WO.QDSTOVLS I
Indicate how many of each type of fixture to be installed or relocated as part of this roject. Do not include existing fixtures to remain.
BATHTUBS (or Tub/shomrcombo) LAVS (H—ds;ok.) Toll WATER PIPING
DISHWASHERS RAINWATER SYSTEMS U ALS OTHER (Describe)
DRAINS SHOWERS CUUM BREAKERS
DRINKING FOUNTAINS SINKS (Eitchen/owity) ATER HEATERS (Electro) y;
HOSE BIBBS SUMPS WASHING MACHINES
Bulletin #100 —April 14, 2010 Page 2 of 3 k:\Handouts\Pem3it Application
..6d
CRITICAL AREAS ON PROPERTY?
WATERPURVEYORSEWER
VRVI;YOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE lin Sgmm Feet)
E STING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
1/1 ❑ Yes ❑ No
❑ Yes ❑ No
Bulletin #100 —April 14, 2010 Page 2 of 3 k:\Handouts\Pem3it Application