00-104142 «TY tF
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ACCESSORY DWELLING UNIT (ADU) •
LAND USE APPLICATION
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RELATED FILE#'S: 6.0 L/C`E'/ / ( S P)
FEE: $113.00 (Not required if legal non-conforming status is established.)
Owner's Name: i ft1
Address: ,r C(9 - 2 5' st .dS ( LcJ).? t,J -
Daytime Phone: a253 `75/6- /7 Tax Parcel#: 1 9/O - 2 a3 )
Zoning: teS Z , Lot Size In Square Feet: R' '( 3 to rG7`
Type of ADU: t❑' Attached ❑ Detached Is this a: l 'New ADU ❑ Existing ADU
Existing ADU was: ❑ Approved by King County(Provide a copy of the permit.) ❑ Other
Construction of existing ADU completed in 19
Construction of existing residence completed in 19 :
Which is the owner occupied unit: la4imary Dwelling.Unit or ❑ ADU
Number of square feet: l.3& 2S Primary Dwelling Unit ADU
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ADU FLOOR PLAN DRAWINGS (Refer to the ADU handout for examples.)
Provide the following:
tr Floor plan of the primary dwelling unit and the ADU.
Git Plumbing (existing&proposed).
Mechanical Heating/Ventilation/Air Conditioning (existing&proposed).
I Entrances of primary Jewelling unit and ADU(existing&proposed).
Ceiling Heights/Room Sizes for ADU.
6 Elevation of the proposed ADU with the primary dwelling unit.
ADU SITE PLAN DRAWINGS (Refer to the ADU Handout for examples.)
Provide the following:
O'Scale/North Arrow. 4er Street/Driveway Location.
Cit Lot Dimensions. Primary Dwelling Unit Footprint.
• ADU Footprint(if detached). tr/Building setbacks from property lines.
ElLocation of utilities and easements. ❑ Show location of three(3)on-site parking stalls.
t! Locate the entrance of the primary and accessory dwelling units.
liCalculate the total impervious surfaces coverage for the site.Include existing and proposed roof area,
driveway,patios,and walkways.
❑ Other
Disclaimer: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
premisis to preform the work for which the permit application is made.
j ) �1'
Signat re of Applicant Date
Waiver:Approval of the ADU Land Use Application does not constitute approval of the building permit.
Application and approval of the building permit is a separate process.
OFFICE USE ONLY
❑ ADU Status:Legal Nonconforming per FWCC 22-339.1: f'New ADU
❑ Assigned Address of ADU
Deed Restrictions/Letters of Application Rec'd. I 'Recording Number 2,4185ro 81(Dares l596
❑ Other
Approved by 9/11. 4041 Le-- Date ')u/o
❑ Conditions of Approval:
City of Federal Way Department of Community Development Services
33530 First Way South,Federal Way,WA 98003 •
(253)661-4000—Fax(253)661-4129
AD
Revised V28/97
•
CONFORMED COPY
20000816001550
HILL
MISC 8.00
PAGE 001 OF 001
KINGBCOUNTY, UA6
After recording,please return to:
Community Development Services Department
City of Federal Way •
33530 1st Way South •
Federal Way,WA 98003-6221 •
CITY OF FEDERAL WAY
ACCESSORY DWELLING UNIT
LE ER OF APPLICATION&DEED RESTRICTION
/2) -/ ,being first duly sworn,on oath do hereby certify under penalty of perjury
under th laws of the State of Washington:
E
That I am an owner of the single family dwelling unit located atC —0/ 6,21,5,ZZ S
Federal Way,Washington.Q &2
That I have made application and received City of Federal Way land use approval for an accessory dwelling unit at this
location.
That I presently occupy and will continue to occupy one of the two dwelling units at this location as my principal and
permanent residence for six months or more of the calendar year.
That this certffiication will remain in effect during the period of my ownership of the property unless I record a
certification with the King County Office of Records and Electio that the use of the property for an accessory dwelling
unit has been discontinued.
Sign re of Applicant
State of Washington)
)ss.
County of King )
On this day personally appeared before me landOt Hi ( I to me known to be the individual
described in and who executed the within and foregoing instrument,and acknowledge that he/she signed the same as
his/her free 412.41.-voltRttry act and deed,for the uses and purposes therein mentioned.
_- GY MFC ��
c'��S J�rt i�tl�and and official seal on this day of W I�( ,-1� Z7
o NOTARY '; 1,, ST�CY T1i �OZZ(
v No he d for Washington,residing at
•
t_� , ' �'
ttl�\ ••S 29-06' : Cr
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••••••''�G My appointment expires: O /� /
Falsely certi ing owner occupancy is subject to a civil penalty of$S,000,in addition to any criminal penalties.