22-100922City of Federal Way
Conununity Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: PETERSON
Project Address: 1003 S 317TH ST
Building - Single Family
Permit #:22-100922-00-SF
Inspection Request Line: (253) 835-3050
Parcel Number: 358400 0270
Project Description: Damage assessment inspection only - home struck by vehicle. ***No construction work
approved under this permit***
Owner
Applicant
Contractor
Lender
DANIEL L PETERSON
LISETTE TERRYDEGENKOLB
1003 S 317TH ST
ENGINEERS
FEDERAL WAY WA
600 UNIVERSITY ST SUITE 720
98003-5334
SEATTLE WA 98101
Census Category: 434 - Residential alt/add - no change in number of units
Includes:
# 1
#2
#3
#4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area (sq. ft.)
Additional Permit Information
Mechanical to be Included? ..................................... No
Plumbing to be Included? ................................... I.... No
Is this an Online or O.T.C. application? .......... I....... Yes
No Fixtures Associated With This Permit 11
PERMIT EXPIRES Tuesday, 30 August, 2022
Permit Issued on Thursday, March 3, 2022
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
VWash
ashin tan and the City of Federal Way.
LOwner or agent: Date:
11TV0
INCIDENT DAMAGE CHECKLIST
DATE OF INCIDENT:
SITE ADDRESS: S I -7
BtULmN ION
33530 First a .0. Box 9718
ederal Way, 8063
Phone { 661-4000/Fax (253) 66141
CASE # -�a /ppaj 2-2
DATE OF INSPECTION:
Nature of Incident/Scope Of Damage:
(If value of damage is greater than 75% of assessed value of structure, a site plan is required)
Building Posted:
❑ NO OCCUPANCY ❑ DANGEROUS BUILDING ❑ OTHER NOT POSTED
Permits Required:
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ ELECTRICAL ❑ DEMOLITION
Plans Required: ❑ Yes ❑ No Plans to show: r A
Engineering Required: I Yes ❑ No Specifically: &W _r ► r-
Demolition Complete: ❑ Yes ❑ No - NA
2" d Inspection Required: ❑ Yes No
Permit Application Information Provi ed To Applicant:
❑ Demolition Permit Application
❑ Building Permit Application
❑ Submittal Checklist
❑ Electrical Permit Application
❑ Other
Inspector
5�35 -;tG39
(253) 6b4--
Phone Number
"APPLICANT .• PLEASE BRING THIS FORM TO THE CITY WHEN APPL YING FOR PERMITS"
RECEIVED PERMIT APPLICATION
CITY OF - - MAR 01 2022 1h y
�r l�� PERMIT CENTER + 33325 8 Avenue South +Federal Wa WA 98003-6325
Federal Way ay 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
�J COMMUN" DEVELOP,MryENT
PERMIT NUMBER „(� _ / i� _ TARGET DATE
SITE ADDRESS
SUITE/UNIT #
1003 S 317th ST Federal Way, WA 98003
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$
RS7.2
385400-0270
TYPE OF PERMIT
® BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Peterson Residence Vehicle Strike Damage Repair
Post damage inspection request for single-family residence having
PROJECT DESCRIPTION
Detailed description of work to
Experienced damage due to a vehicle strike.
be included on this permit only
NAME
PRIMARY PHONE
Dan Peterson
253-670-1737
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
1003 S 317th ST
dpete 1932 c aoI.coni
CITY STATE
ZIP
Federal Way WA
98003
NAME
PHONE
BELFOR, Dave Stephens
206.909.8964
MAILING ADDRESS
E-MAIL
4320 S 131st PL Suite 100
david.stephens@us.belfor.com
CONTRACTOR
CITY
STATE
ZIP
FAX
Seattle
WA
98168
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
BELFOUG99OBJ
12�20/22
602 089 710
NAME
PRIMARY PHONE
Degenkolb, Lisette Terry
206.790.7594
APPLICANT
MAILING ADDRESS
600 University Street, Suite 720
E-MAIL
lterry@degenkolb.com
CITY
STATE
ZIP
FAX
Seattle
WA
98101
NAME
PRIMARY PHONE
PROJECT CONTACT
Degenkolb Lisette Terry
206.790.7594
MAILING ADDRESS
600 University Street, Suite 720
E-MAIL
lterry@degenkolb.com
(The individual to receive and
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
Seattle
WA
98101
NAME
PROJECT FINANCING
Insurance
❑ OWNER -FINANCED
When value is $5,000 or more
(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,
Bulletin #100 —February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
but only where such claim arises out of the reliance of the city, including its offl!cers and-eh}pfoyees, upon the accuracy of the
information supplied to the city as a part of this application.
Q* � T�AA, A
SIGNATURE:
PRINT NAME: Lisette Terry, Degenkolb
TE.February 28, 2022
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application