22-101423-Application-4-6-22-V1PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentergacityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 10000.00
-
TYPE OF PERMIT
iZ BUILDING V PLUMBING ® MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
Tefera residence
Caregiver lounge with bathroom, storage interior addition, interior alterations, Ramp and
PROJECT DESCRIPTION
Detailed description of work to
Conversion of an existing single family residence into an adult -family home.
be included on this permit only
NAME
PRIMARY PHONE
Desta Tefera
206-387-5858
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
32304 9th Ave S
destal06@gmail.com
CITY
Federal Way
STATE
WA
ZIP
98003
NAME
Homeowner
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
Carmelo N Laviste
PRIMARY PHONE
206-6832395
APPLICANT
MAILING ADDRESS
216 NE 175th street
E-MAIL
cnldesign.drafting@gmail.com
CITY
Shoreline
STATE
WA
ZIP
98155
FAX
PROJECT CONTACT
NAME
same as applicant
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY 77STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
® OWNER -FINANCED
When value is $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.
SIGNATURE: c ay e DATE 4-4-2022
PRINT NAME: Carmelo N Laviste
Bulletin #100 — February 19, 2020 Page 1 of 2 k:AHandouts\Pennit Application
MECHANICAL PERMIT $ 300
Indicate how many of each type o fixture to be installed or relocated as part of this r*ct. Do not include existing fixtures to remain.
AIR HANDLING UNITS 1 FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
I
Indicate how many of each (tjpe offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/shower combo) 1 LAVS (Hand sinks) 1 TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitchen/utility) WATER HEATERS (Electric)
HOSE BIBBS SUMPS WASHING MACHINES 3 TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
None
Lake Haven
Lake Haven
$ 9000.00
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Single Family
8190 SF
❑ Yes v No
❑ Yes v No
COMMERCIAL - NEWADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
a
Stories
NEW BUILDING,
ADDITION
COMMERCIAL - E EL/ ENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
Type
Stories
TENANT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:AHandouts\Pennit Application