10-100888 Siiglc.Fam
✓ ` • City of Federal Way • e uilding -
Community Development Services (-)1 %A(3 Permit #: 10-100888-00-S F
P.O.Box 9718
Federal-260. Fax (253)835- Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609 p q
Project Name: A CARING ADULT FAMLY HOME
Project Address: 33014 41ST WAY S Parcel Number: 618141 0090
Project Description: ALT-Permit to establish occupancy for an adult family home.
•
Owner Applicant Contractor Lender
RAPHAEL GALLARDO RAPHAEL GALLARDO
33014 41ST WAYS 33014 41ST WAY S
FEDERAL WAY WA 98001 FEDERAL WAY WA 98001
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
�'?� ,sue .��..
Mechanical to be Included? No . Plumbing to be Included?... ......:..... ....No
PERMIT EXPIRES Wednesday, September 1, 2010
Permit Issued on 2 —5- I 0
I hereby certify that the above information is correct and that the construction on the above described property and
the occupancy and he use will be in .ccordance with the laws, rules and regulations of the State of Washington
0 and the City f Federal Way.
/. % /3I - I/v
Owner or agent.. Date:
$1,eea
FIt4AUb 4/t //Q
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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 CARING ADULT FAMLY HOME Permit#: 10-100888-00-SF
Address: 33014 41ST WAY S
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
Owner Name: RAPHAEL GALLARDO
RAPHAEL GALLARDO
Owner Name:
Owner Address: 33014 41ST WAY S
FEDERAL WAY WA 98001
'% / 3
Building Official Dat
The priority focus in the review and inspection made by the City prior to?issuance of this Certificate was on those matters which
experience has shown most severty 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.
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�� m PERMIT f
} F CO ME EL PL DE EN FP
APPLICATION
1 writ Ro 0 I CrA 5. F,cii,e-,►.A,e td , , JA- cj k oD
SUITE/UNIT a ZONING ASSESSOR'S TAX/PARCEL II
J - Do 9D
NAME OF PROJECT /� l��C 1�I ki 6 A it a,rn■(Tenant or Homeowner Name) ,/C 'Q
i
0 BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
DetOedEdescription o work e r b1 Sh A i' It t •
i
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER R f PHA L O. GALL-,4 R U ) (X3 )q c -- 1,&i
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
3301 I S-' Wa • a r 1,0A ' 8 '01
OWNER IS ALSO: p corntACTOa APPLICANT ❑ PROJECT CONTACT
NAME PRIMARY PHONE
-
1M .IIIGADDRESS,CITY,STATE,ZIP
WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE
NAME PRIMARY PHONE
APPLICANT RA-PHA-EL V. G M-L dR O D >S3 -' - - 171--
MAILING ADDRESS,CITY,STATE,ZIP FAE
, n14 yl Sr V)/ S. feat-rub 'IVY , t4ft •g .�aI -
PROJECT CONTACT NAME - • PRIMARY PHONE
(The individual to receive and S Ot,h1..IL_ Q/1_ tai b O v ' -
respond to all correspondence MAILING ADDRESS,CTTY,STATE,ZIP
concerning this application) IIIIMIIIIII
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCIN t NAME a
OWNER—FINANCED
Requ, -• or L •cts with
valu• ,.1* •' more MAILING ADDRESS,CITY,STATE,ZIP PENURY PHONE•
/RCW 19.27.095 -I,
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the
best of mg 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 authorised by the issuance of a permit I understand that
the issuance of this permit doe*not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
/further agree to hold harmless the City of Federal Way as to any cl aim(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 o the reliance of the city, including its officers and employees,upon the accuracy of the
information — 46 applicatio / h
SIGNATURE: � DATE V h 0
PRINT NAME : 14. itiA „iii /r.'1t 1 I •
Bulletin#100-6/29/2009 Page 1 of 4 lc\I•Iandouts\Permit Application
CC , a .4
Value of Mechanical Work$ (A COPY OF s Is OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be a tailed or relocated asp• .f this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLAC SERTS HOODS(commercie)
BOILERS FURNACES HOT WATER TANKS(cro)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
� O T ,'.
Indicate number of ee ch type e of fixture to be' tailed or relocated as part o '-project. Do not include existing fixtures to remain.
BATHTUBS or Tub/SbowercomboJ A'VS(xanasintry TO , WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URIN e-- OTHER(Describe)
DRAINS SHOWERS VACUUM =' ERS
DRINKING FOUNTAINS SINKS()states/utility) WATER HEATE ' (Electric)
HOSE BIBBS SUMPS WASHING MACHIN - TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF BEEFING IMPROVEMENTS
$
Lakes IV CIA.,"'( 7-. $
EIIISTINO/PREVIOUS USE LOT SIZE(In Syron Peat) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
" RESIDENTIAL`- #
AREA D s, ,RIPTIOII(in square feet) I, EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mo.• -Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
Am rua ntosassc TOTAL
Area Totals
**Aim iross •isr.
ESTIMATED SELLING PRICE$ #OF BEDROOMS
co k I R —NEW/ADDITION:
AREA DESCRIPTION S Area Oceu, . ti Groups) Construction i of Additional Information
in Square Fee Type Stories
NEW BUILDING
ADDITION
1 ° EIAL:-REMADE JTE . IM ROT[E1k NTS ,
AREA DESCRIPTION Area Occupancy Groups) Construction S i of Additional Information
Square Feet Type Stories
TOTAL BUILDiDIQ
TENMrr AREA 010,
rsaaa.AREA ONLY
Bulletin#100–6/29/2009 Page 2 of 4 k:\Handouts\Permit Application