10-102689 ,,
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uilding - Single Tamil
rCity of Federal Way ,//��
comis = Pe It tt. 1 0-102689-00-S F
P.O.Box 9718
Federal Way,WA 98063-9718 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)8 1-2609 ififi s P 4 ( )
Project Name: A MARINE HILLS ADULT FAMILY HOME
Project Address: 29845 6TH AVE S Parcel Number: 515200 0160
Project Description: WABO Inspection and Certificate of Occupancy for Adult Family Home.
Owner Applicant Contractor Lender
WILLIAM MCLAUGHLIN WILLIAM MCLAUGHLIN 29745 6TH AVE S
29745 6TH AVE S 29745 6TH AVE S FEDERAL WAY WA 98003
FEDERAL WAY WA 98003 FEDERAL WAY WA 98003
1
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.) 0 0 0 0
New 1 Additional Sq.Feet-3rd Floor 0 New/Additional Sq.Feet-Basement......... .........0
Mechanical to be Included9 No Plumbing to be Included?.. No
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CONDITIONS:
This parcel is located within a Wellhead Protection Area(Capture Zone 10)and must comply with FWRC
Chapter 19.185 and fill out a Hazardous Materials Inventory Statement,if applicable.
PERMIT EXPIRES Wednesday, December 22, 2010
Permit Issued on Friday, June 25, 2010
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 Washington
and the City of Federal Way.
Owner or agent: U" w �---`� Date: 5 - 2-O/b
F iN 7 Z3//o
1
1
City of Federal Way •
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Section 110.2 of the International Building Code certifying that
at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building
construction or use. This certificate is valid ONLY when endorsed by City staff.
Tenant Name: A MARINE HILLS ADULT FAMILY HOME Permit#: 10-102689-00-SF
Address: 29845 6TH AVE S
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
Owner Name:
WILLIAM MCLAUGHLIN
WILLIAM MCLAUGHLIN
Owner Name:
Owner Address: 29745 6TH AVE S
FEDERAL WAY WA 98003
/0.2.3/4e,
/445141/446' Building O ial Date
The priority focus in the view and inspection made by the City prior to issuance of this Certificate was on those matters which
experience has shown most severly affect the health and safety of the general public. Although the City has made as complete a
review and inspection as is reasonably possible(within budgetary time and personnel limitations), the City neither guarantees nor
warrants to the owner/occupant or to any other person that this Certificate evidences strict compliance with each and every
ordinance or regulation of the City or the State of Washington affecting the construction or use of said structure or the land upon
which it is situated. Such compliance is the responsibility of the owner and/or occupant of the premises. l'
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Federal Way JUN 2 MIT F CO ME EL PL DE EN FP
COMMUMTYDEVELOPMEN 4 i•LICATION N //
253.8352607•FAX 253-8354609 1ti " /
www.atuoffederatwau.com "'" rA
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SITE ADDRESS
- 4 6 ± /4-14:= Wfr kif .g a2
SUITE/UNIT• ZONING ASSESSOR'S TAX/PARCEL A
51 5 Zoo - D / ( 0
NAME OF PROJECT
(Tenant or Homeowner Name) ftANIZitE HILLS '1 ) A 4 i '1A .
❑BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER W Lt.( ,3 y rM c L AL1 4 L..1 n! (206) ( -loot)
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
°I 4 c (dr= v z S. F im h!t"F 'thi'G 3 L ay•
OWNER IS ALSO: E CONTRACTOR r APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP
WA STATE CONTRACTOR'S LICENSE• EXPIRATION DATE FEDERAL WAY ROSINESS LICENSE•
NAME PRIMARY PHONE
APPLICANT =NM
MAILING ADDRESS,CITY,STATE,ZIP
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP
concerning this application) MEM'
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
OWNER PDIANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CPTY,STATE,ZIP PRIMARY PHONE
(RCW 19:27.095) _
I under penalty of perjury that I am the property owner or authorised argent of the property owner.I certify that to the best
of my knowledge,the information submitted in support of this permit application argent and correct.I cermi that I will comply with
best
• applicable City of Federal Way regulations pertaining to the work authorized by the Issuance of a permit.I understand d that the
issuance of this permit does not remove the owner's responsibility for compUaece with local, state, or federal laws regulating
construction or environmental laws.
Ifurther agree to hold harmless the City of Federal Way as to any claim(including costs;acpenses,and attorneys'fees Incurred
in the investigation and defense of such claim), which may be made by any peeves,including the and Jtted against the
city, but only when such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to as of this application.
�/ e
SIGNATURE: /t/ DATE C "Z' '20/0
PRINT NAME: V(11-1-1 M na. t x.}11!{%
Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application
.1, • MECHANICAL FIXTUR
Value of Mechanical Work$ IA COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS 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
PLUMBING FIXTITRES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or'rub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/udIjt WATER HEATERS(ekcrric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
I,r���a L'"n`IE►tA V $ 16 4 000
EXISTING/PREVIOUS USE LOT SIZE(Is Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
�S\ 1\ L of -1 1 ❑Yes/ No ❑Yes /No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT -
FIRST FLOOR(or Mobile Home)
g
FLOOR
7co
COVERED ENTRY
DECK
GARAGE% CARPORT ❑ 2_
OTHER(describe)
PROPOORD Area Totals MOM= TOTAL
."ANW HOMES ONLY""
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL NEW/ADDITION
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet _ Type Stories
TOTAL tRati
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2010 Page 2 of 4 k:\Handouts\Permit Application