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04-102934 0 City of Federal Way SBuildin - Single Family Perm#• 04-102934-00- FCommunitY Development Services P.O.Box 9718 Federal Way,WA 98063-9718 Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 835-3050 Project Name: MONTGOMERY BLA OT A Project Address: 31123 8TH AVE S Parcel Number: 555820 0250 Project Description: NEW-Construc ew '9 I 4< single family residence with-478 sqft attached garage, includes p1 i anica . **4 bedrooms,Estimated Selling Price$280,000** Owner • • u Contract Lender PUGET SOUND HOMES&DEV P. UND HO'w &DEV PUGET SOUND HO &DEV UGET SOUND HOMES&DEV LLC LLC LLC PO BOX 994 PO BOX 994 '0 BOX 994 PUGETSH942L6 08 EDMONDS WA 98020 EDMONDS WA 9: I t ED DS WA 98020 PO ;• 994 EDM' . 9802 ensus Catego : 101 -New si, - e 1 1 it ,o .e, detac I udes: #1 #2 #3 IT, #4 A c ass: R- ons+ i ion Type IllType O • cy Load: Area(sq. ft.) Iii 0 0 , , _ , , ,;,.� riit information' New/Additional Sq.Feet-1st Floor 9 ( dditional Sq.Feet-2nd Floor 1117 New/Additional Sq.Feet-3rd Floor ....0 nal Sq.Feet-Basement 0 Basic Plan? o •ccup. "� -Construction Type Type V-N New/Additional Sq.Feet-De • A• ional Sq.Feet-Garage 478 Mechanical to be Included? .Yesancy#1 -Class tO R-3 Occupancy#2-Class U-1 Additional Sq.Feet-Other 0 Plumbing to be Incl d? Yes Total Building Sq.Feet 2090 New/Additional Sq. -Tota.. 2568 ni ures Ducts... Fans 4 Furnaces 1 Ranges 1 \ir a Bing Fixtures Bathtubs 2 Di- as' . 1 Laundry Washer Outlets 1 Lavatories 4 0 •r Plumbing Fixtures. 2 Showers 1 Sinks 1 -ater Closets 3 Water Heaters 1 CONDITIONS: No Building Final until PW has accepted the street improvements and asphalt overlay for sanitary sewer extension. Street frontage improvements(paving,curb,gutter,sidewalk),and asphalt overlay are required on 8th Ave SW. PET EXPIRES Sunday, December 3007 ' Wirmit Issued on Wednesday, June 1, 2 I hereby certify that the above information is correct and that the construction on the above described property and the occupancy and the use all be in accord ce with the laws, rules and regulations of the State of Washington the City of FeederteW . (--47 A_ , Owner or agent: Date: ��l/ 0 lia Ilikl City of Federal Way ''''S\ ,,, Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.2 o. e Internatio Building Code certifying that at the time of issuance, this+SEructure woes in compliance with the various' ri the City regulating building construction or use. This certificatedlt valid ONLY when endorsed by City sta #10 -"" ile Tenant Name: MONTGOMERY BLA,L8T A "'Permit 04-102934-00-SF Address:431123, TH AVE SW 0. Includes: #1 #2,• ' #3 #4 * 40 ) Occupancy Class: ,. R-3 U-1 41. Fa . Construction Type• Type&V N Type V-N 4•,,.. '"` Occupancy Load I. Floor Area(s•.ft) 0 0 ' a0 .' 0 Owner Name: PUGET SOUND FOMES DEV LLC Owner Address: PO BOX 994 EDMOAS WA 98020 iii ► 40f. Jr 6 'oak Building Official 441' f, 0 i . Date The priority focus in the review and inspection made by the City prior to issuance of this Ceate those matters which experience has shown most seventy affect the health and safety of the gegeral public. Alt ugh t ity hasmade as complete a review and inspection as is reasonably possible(within bpdgetary tine and personnel limitatio , the Citty�hieither guarantees nor warrants to the owner/occupant or to any other person that this gliprtificate evidences strict pliance4rith each and every ordinance or regulation of the City or the State of Washington aff &ting the coruction or use of said structure or the land wpon which it is situated. Such compliance is the responsibility of the owrier and/or aolcupant of the rlre ses. h. THIS CARD IS TO•MAIN ON-SITE CITY iOF tomm'44uni Development Inspection Record t3' p p Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT#: 04-102934-00-SF Owner: PUGET SOUND HOMES & DEV LLC Address: 31123 8TH AVE SW . FEDERAL WAY, WA 98023 This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence On-going inspections are logged on the back of this card. • ❑ Initial Erosion Control(4365) ❑ Footings/Setback(4110) 0 Foundation Wall(4115) To be done prior to breaking ground Approved to place concrete Approved to place concrete By Date By Date By Date • • . - ❑ Drainage/Downspout(4040) ❑ Plumbing Groundwork(4190) 0 Slab/Concrete Floor(4255) Approved to backfill Approved to cover .Approved to place concrete By Date By Date By Date • ❑ Underfloor Framing (4285) ❑ Floor Sheathing(4105) ❑ Shear Walls(4245) Approved to sheath floor Approved to install flooring Approved to install siding By Date By Date By Date • ❑ Roof Sheathing(4220) ❑ Rough Plumbing(4230) ❑ Mechanical Rough-in(4165) Approved to install roofing Approved Approved • By Date By Date By Date ElGas Piping(4125) •❑ Fire/Draft Stops(4095) NOTE Prior to scheduling a Framing(4120) Approved to release test Approved inspection;Electrical,Plumbing&Mechanical i Rough-in and Fire/Draft Stop inspections must be signed off and approved. IBC 109.3.4/UBC 108.5.4 By Date By Date , ❑ Framing(4120) ❑ Insulation(4150) 0 Gypsum Wallboard Nailing(4130) Approved to insulate Approved to install wallboard Approved to install mud&tape By Date By Date • By Date ElFinal Erosion Control (4375) •❑ Final-Mechanical(4065) ❑ Final-Plumbing(4075) • Approved Approved Approved By • Date By Date By Date • • • • ' 0 Final-Building(4050) ❑ Interim Erosion Control(4370) Approved Approved By Date By Date ' For inspector reference only 0 Rough Electrical 0 FINAL-Electrical Approved Approved By Date By Date w. S Y ] - :ity of Federal Way r, • % • 17t1- g mily Permit #: s04 -102934 - 00 - SF Community Development Services ,P.O.Box 9718 Federal Way,WA 98063-9718 - Ph:(253)835-7000 Fax (253)835-2609 Inspection request line: (253) 835-3050 Project Name: MONTGOMERY BLA,LOT ( v i I 1 '0 i� Project Address: 31123 8TH AVE SW Parcel Number:555820 0250 Project Description: NEW-Construct a new 2,090 sqft single family residence with 478 sqft attached garage,includes plumbing&mechanical. **4 bedrooms,Estimated Selling Price$280,000** Owner Applicant Contractor Lender Frank E Montgomery &Jessica R Mo ABBEY ROAD GROUP*TONI STUI GROUND ZERO CONSTRUCTION PFG Northwest 709 23RD AVE ABBEY ROAD GROUP GROUNZC983B4(11-17-06) PO BOX 994 1MILTON WA PO BOX 207 709 S 313TH ST EDMUNDS WA 98020 98354-9308 PUYALLUP WA 98371 FEDERAL WAY WA 98023 Includes: Census category: 101 -New si 1 #1 #2 #3 ir II #4 11 Occupancy Group: 1 R-3 I U-1 — –- H rConstniction Type: r Type V-N Type V-N 117— Occupancy P Y 1 _ g I� Floor Area 4 Ft.): l F `I , 1st Floor Proposed Sq.Feet. 973 2nd Floor Propos Sq.Feet- ,t 1117 ,'j;= ,.,,, Basic Plait... ..... NO; - Census t o 4r•..... a...101 -New single family'how, Occupancy#2-Construction Type ....Type V-N Garage* oposed Sq„Feed , r ,:....478 Mechanical „� ......... Yes , Occupancy#1-Class . - R-3 Occupancy#2-Class U-1 Plumbing Yes Total Building Sq.Feet 2090 Total Proposed Sq.Feet 2090 Plumbing Fixtures Description Quantity;F Description Quantity [ Description (Quantity 1 Bathtubs 2 !1 Dishwashers 1 Laundry Washer Outlets 1 — I Lavatories 1 4 Other Plumbing Fixtures 2 Showers I 1 Sinks 1 Water Closets 3 Water Heaters 7' 1 Mechanical Fixtures Description Quantity__ ! Description Quantity Description ]Quantity. Ducts I 1 IF Fans 4 Furnaces i' I Ranges 1 1 CONDITIONS: No Building Final until PW has accepted the street improvements and asphalt overlay for sanitary sewer extension. Street frontage improvements(paving,curb,gutter,sidewalk),and asphalt overlay are required on 8th Ave SW. PERMIT EXPIRES November 28,2005. Permit issued on June 1,2005 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 __.. Owner or agent: ( i/ ; g Date: 6?//10‘..s / -• • ,f City of Federal Way, Certificate of Occupancy This Certificate issued pursuant to the requirements of Section 110.3 of the Uniform 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: MONTGOMERY BLA,LOT A Permit number: 04- 102934-00 Address: 31123 8TH SW #1 #2 #3 #4 Occupancy Group: R-3 U-1 Construction Type: Type V-N� Type V-N Occupancy Load: Floor Area(Sq.Ft.): Owner Frank E Montgomery &Jessica R Montgomery Name: 709 23RD AVE Address: MILTON WA 98354-9308 Building 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 severely 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. • S DATE INSPECTOR AREA ANI) TYPE OF INSPECTION --1((/ ret r- /07,1 Lam% are- 4 /°00/2- • THIS CARD ISTAIN ON-SITE • • CITY OF Community Development Inspection Record Federal Way IVR INSPECTION REQUEST PHONE # (253) 835-3050 PERMIT #: 04-10291-00-SF Owner: FRANK E MONTGOMERY Address:.2//r3 36666 8TH AVE SW FEDERAL WAY, WA 98023 This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card. 0 Temp.Erosion Control(4365) ❑ Footings/Setback(4110) 'i4 Foundation Wall(4115) To be done prior t'breaking ground Approved to place concrete Approved to place concrete By (iitsc. Date OVA' _ By Date G/•.2j/� • B� ` ' J Date 1 �� b� , ►: Drainage/Downspout(4040) 0 Plumbing Groundwork(4190) 0 Slab/Concrete Floor(42 5) ` Approvedlo backfill Approved to cover Approved to place concrete IL By 0, ��Dater , By Date By Date • • ❑ Underfloor Framing(42 5) 0 Floor Sheathing(4105) 0 Shear Walls(4245) Approved to sheath floor Approved to install flooring Approved to install siding •By FZ, Date 7//3/4>r By• Date By Date g ❑ Roof Sheathing(4220) ❑ Rough Plumbing(4230) 0 Mechanical Rough-in(4165) Approved to install roofing Approved Approved By G_coj Date g- ( - as- By 1-"-';(4C- Date g-'l/—ekr By cdiDate �a • 1 f .0 s...• 0 Gas Piping(4125) ❑ Fire/Draft Stops(4095) NOTE: Prior to scheduling a Framing(4120) Approved to release test Approved inspection;Electrical,Plumbing&Mechanical Rough-in and Fire/Draft Stop inspections must be signed-off and approved. IBC 109.3.4/UBC 108.5.4, By cci Date a-f S' -Q By G, Date .2.5-. 015 "' „ ,__ ._ �, .,. _ ❑ Framing(4120) ❑ Insulation(4150) rAGypsum Wallboard Nailing(4130) Approved to insulate Approved to install wallboard Approved to install mud&tape 4.By G, j Dates .2.1-, Os- By Date B Val''J DateV4, ❑ Final- SWM(4375) ❑ Final-Mechanical(4065) 0 Final-Plumbing(4075) Approved Approved Approved By Date By Date By Date O Final-Building(4050) ❑Temp.Erosion Maintenance(4370) Approved Approved By Date By Date Building Division • CITY OF • 33325 Eighth Avenue South Federal Way • PO Box 9718 Federal Way 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS: 51/ 13 1 -1/1 1,v?' Ct #: D -/OZ 93 it @ D ',Ali 5 al) jo e ( inn te+-e i , tA,.e I ® ar✓ -c , T r-e� .oof � e l>s1Y h lis in �� � �� �tr�r S a�n� ��f Ike yoriyet INA dosol', I aich I i h- A f w lk, s g �t Wall �►v i nailp 11 '*9 t'cat int rm`eikJ7'er5 r k. 1\)0 1: ki . 1- f ---I/ K IF YOU HAVE ANY QUESTIONS CALL 111, (A0 /9 /_? (253) 835- 2- 2 31 Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. S BACK OF CARD FOR DETAILS. /.)-.21/4 -5 117 DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page of Building Division ' CITY OF 33325 Eighth Avenue South Federa ay • PO Box 9718 Federal Way 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS: 3///23 A-1/6- cr") #: Dy /U 2-' �o /ye7 02y oft./~ v/t/T?e -c4 1/e// 7Z t IF YOU HAVE ANY QUESTIONS CALL pfriftvito ieri (253) 835- 26 z- Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD FOR DETAILS. DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page 3 of 4110 N. CITY OF Building Division �. FederaNay • 33325 Eighth Avenue South PO Box 9718 Federal Way,WA 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS:,( ( Z3 b- ,¢cc'-9 . S.CA J . #: 0917- /4 Z. it75 .-:©c3 •_,..w-- p °' /V. "74 ye-pt 4 ,4 i..... f .S,64=7 .,/d 4 ___I ___,-/IM- 040 e AL, /e.- 111/8/ ---/Cv./. . Vii° e a / a ie' . ,•� ./ 44 Nit-- - ,42,a.;., fee, (e.N. is, mac.. /ep -..- - 4-" e.... .:5),(41,46 f' 01 ‘tri_ C_ A 74:0.,4..e.._ �G ' )1,,e---' G' otv-� ' `"O �� ioe.c.), ' i r 1 I 1 IF YOU HAVE ANY QUESTIONS CALL 6, / /< a G 3-835- �62-1 Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL 253-835-3050 FOR RE-INSPECTION. SEE BACK OF C RD FOR DETAILS. DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page \ of f � Building vision 41/46, CITY OF • 33325 Eighth Avenue South Fede ra ay • PO Box 9718 Federal Way 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS: 3// 3 - e Aw S1J #: 0c77/O 2 13 V-- coo - �= 7( )3,s/ 6)/ r�✓ 49 .-,s�✓/1-":: 1Er- 1-G ' -A✓T fr-L 6— •0c,c_ 72e l - Cwt- .C.1.0.,,t o- )) V i IF YOU HAVE ANY QUESTIONS CALL til (253) 835- 262-3 Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD FOR DETAILS. dc)/"/°cr rc '/INSPECTOR DO NOT REMOVE THIS NOTICE Page 1 of Building Division • CITY OF • 33325 Eighth Avenue South Federal Way . PO Box 9718 Federal Way 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS: 3// Z{3 #: a`/E.iez,6' -2vA,, -2 2 " -7 c 77 / it 2 4 7 5/72-i ,e4, IF YOU HAVE ANY QUESTIONS CALL (253) 835- 26 2 3 Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD FOR DETAILS. DAT INSPECTOR DO NOT REMOVE THIS NOTICE Page of VP , " NI, • ' 0 • ' Building DiVisio CITY OF n • 33325 Eighth Avenue South ... ..,, Federal Way • PO Box 9718 Federal Way 98063-9718 Phone 253-835-2607 Fax 253-835-2609 INSPECTION NOTICE ADDRESS: 3//2-3 - ' frl/ 22tJ #: 5/1:--- () c. )-71.1-1/2----7--6,--- A_,--. ,, ,//z -D '4 ,s77.7-43,5, 00, 7: ve- @; ,' ,2/ /e-fit-(72//elex e,o-z- 472/,/.- :_) t1.L7r14-4_ 77/„:" /114' Lt--55 77-/-n-11/aft/ /AW 7174/e /4---ti22 I X " /„.°/vez 47. 7.Zi' Aii--re /..)/-" z..e- ix)7a4'z--4 kpcnic--- wm--41 312 5), df /TS izii 4-)77? . A1e - - i7 /3cFP .71-7vi--11 76 ar-c• 14 -/ 72:-)-- /1-z -OL( ,4-7,/,9 7 c-74--ai /0-t-7 Cr- 4,1101//Alf, /';I /72/ Ale:7- 45-S 7? f"-/ód /7 ,0-,(J- ,f- -- cp--cii c,foc • (687,, (9) . (- ) _.4---- -J-tt-- 1---7272--- 1--1--y)-7,z,t-timr.c„ ç7L-- At16/4/ _I-/1-/-5/91 -7-76Ai• . IF YOU HAVE ANY QUESTIONS CALLk' -4/014 kin4/1/4 (253) 835- Call for reinspection before cover WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD FOR DETAILS. ---- ( 7 ^ `r rlYr DATE INSPECTOR ' 0 NOT REMOVE THIS NOTICE Page / of ) (2e3 �144 e_ CONSTRUChON PERMIT APPLICATION • CITY OF �a. ` APPLICATION NUMBER: ® ‘.'` 0:_or Federal . • APPLICATION NUMBER: _ „---�, no, - APPLICATION NUMBER: _' t T ollowing is re it d information—Please print(in ink)or type** �jf• -ase note: Electrical,Fire Prevention Systems and Engineering permits may require a separate application. X PROPERTY INFORMATION - Gram S W SITE ADDRES 3121 Street and 8th Ave. SW ASSESSOR'S TAX/PARCEL#: 5558200250 ,V LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY): Please see attached. X PROJECT INFORMATION TYPE OF PROJECT(This application): X BUILDING X PLUMBING X MECHANICAL❑ DEMOLITION o ELECTRICAL ENGINEERING ❑ FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description): Residential Single Family Building Permit(Lot#1) _^ PROJECT NAME: Montgomery 8th Ave. Project X PROJECT INFORMATION PROPERTY OWNER: NAME: DAYTIME PHONE: Frank&Jessica Montgomery 206.412.3112 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): 709 23rd Ave.SW,Milton,WA 98354 CONTRACTOR: NAME: DAYTIME PHONE: Ambrosia Homes 253.841.1753 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: P.O. Box 581,Puyallup,WA 98371 N/A CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER:TBD FAX NUMBER: 253.446.3158 CONTRACTOR'S REGISTRATION NUMBER: EXPIRATION DATE: (copy of card required) A M B R 0 H L 99 B9 02/03/06 APPLICANT: NAME: DAYTIME PHONE: Abbey Road Group(Toni Sturdevant) 253.446.3516 MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): EVENING PHONE: P.O. Box 207,Puyallup,WA 98371 N/A RELATIONSHIP TO PROJECT: FAX NUMBER: o ARCHITECT ❑TENANT X OTHER(DESCRIBE):Agent 253.446.3159 E-MAIL ADDRESS: CONTACT PERSON FOR THIS PROJECT: ❑ PROPERTY OWNER X APPLICANT ❑ CONTRACTOR tonis@abbeyroadgroup.com X PROJECT INFORMATION EXISTING USE: Vacant EXISTING BUILDING ASSESSED/APPRAISED VALUATION $ PROPOSED USE: S/F Residential New Construction PROPOSED VALUATION FOR IMPROVEMENTS: $TBD SPRINKLERED BUILDING? ❑YES X NO FIRE SUPPRESSION SYSTEM PROPOSED/R4@ X NO WATER SERVICE PROVIDER: X LAKEHAVEN o HIGHLINE o TACOMA ❑PRIVATE(WELL) UL3 SEWER SERVICE PROVIDER: X LAKEHAVEN ❑HIGHLINE ❑PRIVATE(SEPTIC) wl ' z004 CITY OF FEDERAL WAY BUILDING DEPT. • I .**NSW RESIDENTIAL CONSTRUCTION ONLY** L NUMBER OF BEDROOMS: 4 ESTIMATED SELLING PRICE: $ 280,000.00 ■ PROJECT FLOOR AREAS FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL BASEMENT N/A N/A N/A FIRST N/A 973 973 SECOND N/A 1117 1117 / THIRD N/A N/AN/A //ICN //� FOURTH N/A N/A N/A OTHER FLOORS(DESCRIBE) N/A N/A N/A DECK N/A N/A N/A GARAGE N/A 478 478 HOW MANY FLOORS? 2 N/A 2568 Sq.Ft. 2568 Sq.Ft. TOTAL: • FIXTURES Indicate number of each type of fixture MECHANICAL$5,750.00 AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S) BBQ(S) 4 FAN(S) HOOD(S) WOODSTOVE(S) BOILER(S) FIREPLACE INSERT(S) 1 RANGE(S) MISC.( ) COMPRESSOR(S) 1 FURNACE(S) X DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: ❑ ELECTRIC X GAS PLUMBING 2 BATHTUB(S) 4 LAVATORY(S) URINAL(S) 1 WATER HEATER(S) 1 DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) X ELECTRIC o GAS DRINKING FOUNTAIN(S) 1 SHOWER(S) 1 WASH MACHINE OUTLET GAS PIPE OUTLET(S) 1 SINK(S) 3 WATER CLOSET(S) MISC.( ) INTERCEPTOR(S) SUMP(S) ■ DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 aim),which may be made by any person,including the undersigned,and filed against the City of Federal Way,but only where suc claim arises out of the reliance of the city,including its officers and employees,upon the accuracy of the information supplied to th city as a part of this application. 1 NAME/TITLE: g�'i _ �--` .t '1 1 �j j`' V 1I -`X� C .611 J DATE: U'--t 4 O V ❑ PROPERTY OWNER X APPLICANT ❑ CONTRACTOR FOR OFFICE USE ONLY, ❑ NEW o ADDITION. ❑ALTERATION ❑ REPAIR 0 TENANT IMPROVEMENT CENSUS CODE: LOT SIZE: ZONING DESIGNATION : BUILDING SHELL ONLY? o YES o NO COMP PLAN DESIGNATION BASIC PLAN? to YES ❑ NO SECTION TOWNSHIP RANGE NEW ADDRESS REQUIRED? 0 YES 0 NO PLATTED LOT? ❑YES ❑ NO CHANGE OF USE? D YES o NO COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129