10-104771 • • 3uilding - Single Family
City of Federal Wa4
Community Development Services Permit #: 10-104771 -00-SF
P.O.Box 9716 •
Federal Way,WA 98063-9718 Inspection Request Line: (253)
Ph:(253)835-2607 Fax:(253)835-2609 p q 835-3050
Project Name: ANGEL HOUSE AFH LLC
Project Address: 31903 42ND AVE SW Parcel Number: 873198 3080
Project Description: ALT-Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner Applicant Contractor Lender
AMY WESTRICK AMY WESTRICK
4631 SW 333RD CT 4631 SW 333RD CT
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
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
t AdditionatPermit Information
New/Additional Sq.Feet-3rd Floor 0 New/Additional Sq.Feet-Basement 0
Mechanical to be Included? No Plumbing to be Included? No
� 5
No Fixtures Associated With T tis Permit!!
,IAA& s.2....• .,�„3. L �' '..y9
PERMIT EXPIRES Sunday, May 8, 2011
Permit Issued on Tuesday, November 9, 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: ' `� � Date: ��—1 D / 0
FIN I1f3 //
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: ANGEL HOUSE AFH LLC Permit#: 10-104771-00-SF
Address: 31903 42ND AVE SW
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq. ft.) 0 0 0 0
Owner Name: AMY WESTRICK
AMY WESTRICK
Owner Name:
Owner Address: 4631 SW 333RD CT
FEDERAL WAY WA 98023
ill--fria'714B ding Official ate
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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CITY OF A °PERM IT
EN FP
Federal WcWayAE9-rivE)1),
COMMUNITY DE L ELOPMENT SERVICES APPLICATION
253-835-2607•F.4X 253-835-26098 I Q
www.dt4offederalwa4.rom NOV 2010 ��
SITE ADDRESS Li 1 Y OF FE1t'
WAY
'lift3/ 13 g2 - VcsiJ c �' %/e) 3 CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
$ g- 7-- 3 / 9 8' _ / 4 ( o
TYPE OF PERMIT 7, X BUILDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT (--, 1 4%
(Tenant tVame/Homeowner Last Name) friG( !/
PROJECT DESCRIPTION /�� /��J C� 111)11 --- _ " '
Detailed description of work to 4,pvt r �'1/1�l// �� 7—(t -,' T--
be included on this permit only
If /
NAME PRIMARY PHONE
PROPERTY OWNERKi 44_ 2ALlitiy .-
MAILING ADDRESS _ E-MAIL
C-14:1---443e-,1-3-
1.1I '7 ti
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CITY STATE ZIP ` 4:07✓
" ,A /2-At (L-.SAY 1t'/F eD,?-3
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
<
N .., --13
PHONE
3 1'i l - 3/6A
APPLICANT MAILING/ADDRESS E-MAIL
/- i kS'- J 33.3 ..t) C:# . an /qc fire
CITY r STATE ZIP FAX
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PROJECT CONTACT NAME PHONE
IecTP—i d— ?� �, )C 3/ C�.�
(The individual to receive and fudel C1/
respond to all correspondence LINADDRESS E-MAIL
concerning this application) ,�
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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: d2� d'%i
It, ,c - /cc DATE L•
A1"Y 4, ,2v/4
PRINT NAME: IIIA d.I c G�.J
Bulletin#100-April 14.2010 Page I of 3 k:AHandouts\Permit Application