18-101307Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST
Code References: 2015 IRC Section R326 (WAC 51-61) t
APPLICATION NUMBER: ®� D P 3 0 7
SECTIONS 1. 2. 3. AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPEC71ON WALL BE PROCESSED
SECTION PROPERTY INFORMATION
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SITE ADDRESS:
PROPERTY OWNER NAME: Ztff 67 W e 'iAwAgZ
TAWPARCEL#------------
DAYTIME
_____ ____
DAYTIME PHONE 23 Z C d Z
AFH LICENSEE NAME gF DwFBtwn: &`ll�tt W 6,-1 m y'6 y DAYTIME PHONE:
SECTION 3 - FLOOR PLAN
25.3 232 6 1-2,
On a separate sheet of paper (81/2 x ii) draw a floor plan (including all
floors) of your prospective AFH. Include all sleeping rooms (bedrooms)
indicating which bedroom is: A. B, C % E and F.
Label all components for exiting i.e., stairs, ramps, platforms, lifts and
elevators.
SECTION•BLOCK
I certify under penalty of perjury that the information furnished by me Is true and correct the best of my knowledge, and that I am
requesting or I am authorized byy the owner of the above premises W request inspection for the operation of an Adult Famlly Home
at this location. I agree to hot) harnlle% the jurisdiction conducting such inspections, at my request, as tD any claim (including costs,
expenses, and attorneys' fees incurred in the investigation of such clam), which may be made by any person, including the undersigned,
and fled against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, including its officers and
employees, upon the accuracy of the information suppled t�,o, the jurisdiction as a part of this application.
NAMEITITLE: Cl
& id awbu �. �._D41 r1 na-DATE: 0.3 %/
(PROPERTY OWNER
(Effective July 1, 2013.)
0APPLICANT LICENSEE
Effective: 2013 July 01
Updated: 2017 February
minimum and 30 inches maximum.
R325.8.3.1 Fixed position grab bars. Fixed position grab bars shag be a minimum of 36 inches in length and start 12 inches from
the rear wall.
8325.8.3.2 Sw Ing -up grab bars. Sw ing-up grab bars shag be a minimum of 28 inches in length from the rear w all.
R325.8.4 Grab bars at bathtubs. Horizontal and vertical grab bars shag meet the requirements of R325.8.
R325.8.4.1 Vertical grab bars. Vertical grab bars shall be a minimum of 18 inches long and installed at the control end w all and
head end w all. Grab bars shag mount w ithin 4 inches of the exterior of the bath tub edge or w ithin 4 aches w ithin the bath tub. The
bottom end of the bar shag start between 36 inches and 42 inches above floor grade.
EXCEPTIOR The required vertical grab barcan be substituted with a floorto ceiling grab bar meeting the
requirements of R326.8 at the control end and head end entry pants.
8325.8.4.2 Horizontal grab bars. Horizontal grab bars shag be provided at the control end, head end, and the back w all w ithin the
bathtub area. Grab bars shag be mounted betw een 33 inches and 36 inches above floor grade. Control end and head end grab bars
shall be 24 inches minimum in length. Back wag grab bar shag be 36 inches minunum in length.
R325.8.5 Grab bars at shower stalls. Where show er stalls are provided to meet the requirements for bathing fackies, grab bars
shag meet the requirements of 8325.8.
EXCEPTIOR Shower stalls with permanent built-in seats are not required to have vertical or horizontal grab
bars at the seat end wall. A vertical floor to ceiling grab bar shall be installed within 4 inches of
the exterior of the shower aligned with the nese of the built-in seat.
R325,8.5.1 Vertical grab bars. Vertical grab bars shag be 18 inches minimum in length and installed at the control end w all and
head end w all. Vertical bars shall be mounted w ithin 4 inches of the exterior of the show er stag or w ithin 4 inches inside the show er
stag. The bottom end of vertical bars mount betty een 36 inches and 42 inches above floor grade.
8325.8.5.2 Horizontal grab bars. horizontal grab bars shag be installed on all sides of the show er stag mounted betw een 33
inches and 36 inches above the floor grade. Horizontal grab bars shag be a maximum of 6 inche s from adjacent w alis. Horizontal
grab bars shag not interfere w ith show er control valves.
8325.9 Ram ps. All interior and exterior ramps, w hen provided, shag be constructed in accordance w ith Section 8311.8 w ith a
maximum slope of 1 vertical to 12 horizontal. The exception to R311.8.1 is not allow ed for adult family homes. Handrails shall be
installed in accordance w ith 8325.9.1.
R325.9.1 Handralls for ramps. Handrails shall be installed on both sides of ramps between the slope of 1 vertical to 12 horizontal
and 1 vertical and 20 horizontal in accordance w ith 8311.8.3.1 through R311.8.3.3.
8325.10 Stair treads and risers. Stair treads and risers shall be constructed in accordance w Rh R311.7.5. Handrails shag be
installed in accordance with 8325.10.1.
R325.10.1 Handrails for treads and risers. Handrails shag be installed on both sides of treads and risers numbering from one riser
to multiple risers. Handrails shag be installed in accordance w ith 8311.7.8.1 through 8311.7.8.4
8325.11 Shower stalls. Where provided to meet the requirements for bathing facilities, the minmum size of show er stags for an
adult family home shag be 30 inches deep by 48 inches long.
[Statutory Authority: RCW 19.27.031 and chaptars19.27 and 34.05 RCW.13-04-068,§51-51-0325, filed 2/1/13, effective 711/13. Statutory
Authority: Chapter 19.27 RCW.10-18-036, § 5151-0325, filed 8/25/10, effective 9/25/10. Statutory Authority: RCM9.27.190,19.27-020, and
chapters19.27 and 34.05 RCW. 09-04-023, § 51-51-0325, filed 1/27/09, effective7/1/10.StatubryAuthodty:RCW 19.27.074,19.27.020, and
chapters19.27 and 34.05 RCW. 07-01-090, § 51.51-0325, filed 12/19/06, effective 7/1/07. Statutory Authority: RCW 19.27.031 and 1927.074.04-
01-109, § 51-51-0325, filed 12/17/03, effective 7/1/04.1
Effective: 2013 July 01
Updated: 2017 February
NAME OF AFH: i!�i Y)Q L a V e
SECTION5A TBE COMPLETED BYTHEBUILDING DEPARTMENT INTHEJURISDICTIONTHE HOME WILL BE LOCATED
PLEASE CHECK ALL APPLICABLE BOXES; MATCH THE LIST BELOW TO THE APPLICANT'S FLOOR PLAN —USING THEIR PROSPECTIVE RESIDENT
BEDROOM DESIGNATIONS OF A 8 CD E AND F AND CLASSIFICATION CODE S, NS1 OR NS2.
SECTION i O•'S INSPECTION
R17r. 1 Clncnina Rnnm flaccifvatinn• rarh daaninr mnm in an Adult family Hnm Shall be dassified as:
Type S —where the means of egress contains stairs, elevators or platform lifts to evacuate residents to public area.
Type NSI — where 1 means of egress at grade level (has no stairs) or ramp constructed compliant with 8325.9 is provided to evacuate residents to public area.
Type NS2— where 2 means of egress at grade level (berth have no stairs) or ramps corutntcted compliant with R325.9 are provided to evacuate residents to public area.
SLEEPING ROOM A Type S jWype NS1 10 Type NS2
YES NO
Closet door/s arereadilyopenablefromtheinside lWes 1E3No I Smoke alarm is installed inthebedroom
Q
Bedroom door opens ea sily and quickly from the outside when I ocked
Q Q
SI eepi ng room window has a net opening of 5.7SF (mi nimum dimensions at least 24"high; at I east 20" wide)
EXCEPT per R310.2.1: at -grade escape wi ndows —may have net clearance opening 5 SF
Q
SI eepin room window has amaximums ill hei htof44"abov+efloortoclearo enin nosteps underwindowallow
SLEEPING ROOM B E3 Type S pe NS1 10 Type NS2
Closet door/s are readily o enablefromtheinside es No Smoke alarm is installed in the bedroom
F[3[E33
Bedroomdoor opens easilland quicklyfrom the outside when Iocked
SIeeping room wi ndow has a netopening of 5.7SF (minimum dimensions at Ieast 24"high; at I east 20"wi de)
EXCEPT per 8310.2.1: at -grade escape windows —may have net clearance opening 5 SF
Sleepi nroom window has amaximum sill height of44"abovefloor toclear o erdn ;poste sunderwindowallow
SLEEPING ROOM C 1 E3 Type S jWype NS1 JU Type NS2
YES NO
Closet door/s are readilyo enablefromtheinside lWes 1[3No I Smoke alarm is installed in the bedroom
Q
-Bedroom door opens ea sily and quickly from the outside when Iocked
Q Q
SI eepi ng room wi ndow has a net opening of 5.7 SF (minimum dimensions at least 24"high; at l east 20" wi de)
EXCEPT per R310.2.1: at -grade escape wi ndows —may have net cl earanoe opening 5 SF
13
Sleepi n room window has amaximumsill height of 4Vabove floor toclear o ervn ; o stepsunderwindowallow
SLEEPING ROOM D Type S jWype NSI JU Type NS2
YES NO
Closet door/s are readily o enable from the inside1[0-fes 113No I Smokealafmisinstalled inthe bedroom
Q
edroomdoor opens easiland quickly from the outside when Iocked
Q Q
SI eepi ng room wi ndow has a net o pening of 5 J SF (minimum dimensions at I east 24"high; at least 2(r wi de}
EXCEPT per R310.2.1: at -grade escape windows —may have net clearance opening 5 SF
Q
SI eepi ng room wi ndow has a maximum sill height of 44" a bovie fl oor to clear opening; no steps under window a Ilowec
SLEEPING ROOM E Type S JUTypeNS1 IU Type NS2
YES NO
Closet door/s are readily o enable from the inside Yes No Smoke alarm isinstaNedinthe bedroom
Q Q
Bedroom door opens easil and quickly from the outside when Iocked
Q Q
Sl eepi ng room wi ndow has a net opening of 5.7SF (mi nimum dimensions at I east 24"high; at I east 2W wide)
EXCEPT per R310.2.1: at -grade escape wi ndows —may have net clearance opening 5 SF
El Q
Sleepi nroom window has amaximum sill het tof44"abovefloortoclearopening; no stwindow.allowec
E3
SLEEPING ROOM F I E3 Type S JE3 Type NS1 JE3 Type NS2
YES NO
Closetdoor/s are readilyopenablefromtheinside 113Yes No I Smokealarm is installed in the bedroom—
Bedroom door opens easily and quickly from the outside when locked
Sl eepi ng room window has a netopening of 5.7 SF (mi nimurn dimensions at least 24"high; at I east 20"wi de)
EXCEPT per R310.2.1: at -grade escape windows —may have net clearance opening 5 SF
Q Q
Sleepi nroom window has amaximum sill height of 4Vabovefloortoclear opening; nost sunderwindowallow
Effective: 2013 July 01
Updated: 2017 February
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CITY OF
Federal Way
PERMIT NUMBER /Y
RECEIVED PERMIT APPLICATION
MAR 2 2 2018
CITY DF FEDERAL WAY
GOMMUNfTY�jpEyELOP ry�
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SITE ADDRESS / 3S t4
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SUITE/UNIT N
PROJECT VALUATION
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ZONING
ASSESS T� ARCEL VT O � it � _
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TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
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Detailed description of work to
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be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS
E-MAIL
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CITY
STATE
ZIP
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NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
zz S zs A3
MAILING ADDRESS
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E-MAIL
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APPLICANT
TY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
1 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. 1 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.
1 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 a part of this application.
SIGNATURE: I DATE C_
PRINT NAME: eSZ41qP N ;/7,1
Bulletin #100 — February 22, 2016 Page 1 of 2 k:\Handouts\Permit Application
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CITY OF
Federal Way
PERMIT NUMBER /Y
_
RECEIVED
MAR 2 2 2018
Com' OF FEDERAL WAY
COMMUNfTy DEyELOP
PERMIT APPLICATION
TARGET DATE C7:�
SITE ADDRESS /f / /� 3 2� i- )L �Jax� , , 5,n (AA 966-73
SUITE/UNIT #
PROJECT VALUATION
$
ZONING
ASSESS TAX/PARCEL #O -
—
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
} yk / d t
PROJECT DESCRIPTION
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Detailed description of work to
a /t (I S p
be included on this permit only
NAME
PRIMARY PHONE
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PROPERTY OWNER
MAILING ADDRESS
E-MAIL
3 T# P1
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CITY
STATE
ZIP
(./Y1
916a 2 S
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
Z S A324
MAILING ADDRESS
E-MAIL
APPLICANT
TY
STATE
ZIP
FAX
GOE A
/)
-211
-ALd
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
1 certify under penalty of perjury that 1 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.
SIGNATURE: + DATE 09 I / iP1 2'-i 6'
PRINT NAuz: YC41qP N 1A/qifiVO
Bulletin #100 - February 22, 2016 Page 1 of 2 k:\Handouts\Permit Application
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