10-100020 .* R
City of Federal Way III euilding - Single 1 a nlily
Community Development Services Permit #: 10-100020-00-SF
P.O.Box 9718
Federal Way,WA 98063-9718 FILEec
Ins tion Request Line: (253)835-3050
Ph:(253)835-2607 Fax (253)835-2609 p Q
Project Name: JUST LIKE HOME AFH,LLC
Project Address: 31420 41ST AVE SW Parcel Number: 873198 2510
Project Description: NEW-Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner Applicant Contractor Lender
KURT&JENNIFER KESELBURG DARA&WAYNE MANDEVILLE
3350 S 269TH ST 29825 45TH AVE S
KENT WA 98032-7033 AUBURN 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
New/Additional Sq.Feet-1st Floor..................0 New/Additional Sq.Feet-2nd Floor....... .........0
New/Additional Sq.Feet 3rd Floor.. .........0 New/Additional Sq.Feet-Basement 0
Basic Plan? No New/Additional Sq.Feet-Deck 0
New/Additional Sq.Feet-Garage 0 Mechanical to be Included? No
New/Additional Sq.Feet-Other 0 Plumbing to be Included? No
New/Additional Sq.Feet-Total 0
4 f t ' fated,With it Ii , r
PERMIT EXPIRES Sunday, July 4, 2010
Permit Issued on Tuesday, January 5, 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 th ity of Federal Way.
Owner or age : l AIL • i 110. .:.Jl Vc ' Date: 0k J`0-0 10
ciN*aa' i /& fiO
. T ,
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: JUST LIKE HOME AFH, LLC Permit#: 10-100020-00-SF
Address: 31420 41ST AVE SW
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
Owner Name: KURT&JENNIFER KESELBURG
KURT&JENNIFER KESELBURG
Owner Name:
Owner Address: 3350 S 269TH ST
KENT WA 98032-7033
A14(9144 ,� i�s /4/7-4v
hng Official Date
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 sever-1y 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.
A y
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RECEIVED 0 - / 0 0 0 0
n-o, AN Q 5 ?C'0111) PERMIT ) \ F MF CO ME EL PL DE EN FP
Federal Wa�
COMMUNITY D�T 4EDERAi LICATION
253-835-260 2 -8 - 09
www.cityoffederalwau.com CDS
PROPERTY.
SITE ADDRESS 14 20 - ! I Avenue 5W' rec e a\ �C l WA 613.°
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL# JJJ
,
PROJECT
NAME OF PROJECT - �J tA,s-V L1 14--e- f �Y1�
(Tenant or Homeowner Name)-} *LC
I
❑ BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
r» i U frK 0 in Cit>i )e utSA- t\€e . a
PROJECT DESCRIPTION int i i 1 �,� I is 6`./11 1.6 � I^C '
Detailed description of work to V w L� W�"� tl ! 1 V L���� 1
be included on this permit only J
PEOPLE
NAME PRIMARY PHONE
PROPERTY OWNER &U((-- -Ir. je `V\i -r-"/ ,•Pse ( k 1I - (955)85a-O a.b
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
33srb S. dtpq s-r u.en-�iv0A61� 1(v("Fact s-�.
OWNER IS ALSO: Otpc. 0 CONTRACTOR 0 APPLICANT ❑ PROJECT CONTACT
fc.,
NAME (/ PRIMARY PHONE
l )
CONTRACTOR
MAILING ADDRESS,CITY,STATE,ZIP FAX
-
i,Pt WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE (FEDERAL
WAY BUSINESS LICENSE#
/ /
NAME ' ;/y� (� 1 PRIMARY PHONE
APPLICANT +Ca) 0+- }""k-x.1'-1 ,��� mV `1(la )5D 1 -5c)57.)
CA Y,STATE,
Cv�S- Li MAILING ADDRESS,
S/We
ZIP SJ, A,W\,"V/c"W( ( ) FAX
PROJECT CONTACT NAME�� (� } x PRIMARY PHONE
(The individual to receive and ^j' """\ ��CJIa/\.1 `� cO'—' )5 )
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) -a5 45 Pcve S - A'.1/40.,. A ctgue f ( ) A1A-_
ALTERNATE NAME: PRIMARY PHONE �^r�—� +NI�AIL
� can
��` .
W V\Q-- (,)3(c." )333-2L,01S ( { tt
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects withiV -
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY 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
a part of this application.
SIGNATURE: �`V i0JL.,91/4cS), ),,)''61Q DATE OROS 1 0 ,
PRINT NAME: a V 1 k.{--
Bulletin#100-January 1,2010 Page 1 of 4 k:\Handouts\Permit Application