17-104054 Building - Single Family
City of Federal Way Permit #:17-104054-00-SF
Community Development Dept.
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: ESTHER ADULT FAMILY HOME
Project Address: 3923 S 328TH ST Parcel Number: 614360 0580
Project Description: ALT-Inspection of residence for compliance with requirements for Adult Family Home.
***No Construction Approved with this Permit***
Owner Applicant Contractor Lender
CARL-MATH INTERNATIONAL FOLASHADE
LLC AKINLOSOTUESTHER ADULT
29810 44TH AVE SW FAMILY HOME
FEDERAL WAY WA 98023 29810 4TH AVE SW
FEDERAL WAY WA 98023
USA
Census Category: 434-Residential alt/add - no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class: R-3
Construction Type: Type V-B
Occupancy Load:
Floor Area(sq.ft.)
Additional Permit Information
Occupancy#1-Construction Type Type V-B Mechanical to be Included No
Is this an Online or O.T.C.application9 Yes Plumbing to be Included2 No
NO 1Ft bx �� t44/xllktith Th€t 11
/s
PERMIT EXPIRES Sunday, 18 February,2018
Permit Issued on Tuesday,August 22,2017
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: G� t,`--N, • Date: e 1-2---Li 1
R325.8 Grab,Bars in Bathrooms N/A 0 YES NO
Grab bars shall be installed for all water closets(toilets),bathtubs and showers according to R325.8. 0
Water Closets(toilet)shall have grab bars installed on both sides according to R325.8—R325.8.3.1 or R325.8.3.2. I 0
Bathtubs shall have two vertical and three horizontal grab bars installed according to R325.8-R325.8.4—R325.8.4.2
Shower stalls have two vertical and horizontal grab bars mounted on all sides of shower according to R325.8—R325.8.5—
R325.8.5.2.
Shower stalls must be minimum size of30 inches deep by48 inches long(R325.11) 0 0
AG103—AG105 Swimming Pool,Spa, Hot Tub YES NO
AF105.2 Must be surrounded by a barrier that is 48 inches high,may have doors and or gates that must have audible alarms when 0 0
opened.
AG105.5 EXCEPTION: Pools,Spas or Hot Tubs with a safety cover which complies with ASTM F 1346 0 0
0 PASSED QcORRECTIONS REQUIRED 0 PERMIT REQUIRED
ose,D
INSPECTOR'S NAME(PRINT)
INSPECTOR'S SIGNATURE v DATE:
INSPECTOR'S (/ C(� `0-77e; ( tel/ IciL. z-S3 r7/?f 2,ea /
OFFICE ADDRESS PHONE NUMBER:
Application and inspection checklist developed by Washington Association of Building Officials(WABO),in cooperation with Department of Social and
Health Services(DSHS)for use by both departments and licensors. 07/01/2013
Effective:2013 July 01
Updated:2017 February
GENERAL YES NO
Bathroom doors are easily and quickly openable from the outside when locked or 0
Carbon Monoxide alarms a re installed as required i n R315 on each level of the home. 0 0
Smoke alarms are installed on all levels of the dwelling,in each resident sleeping room,outside each separate Er 0
sleeping a rea i n the i mmediate vi cinity of sleeping rooms(R314).
Smoke and Carbon Monoxide alarms a re installed i nsuch a manner sothattheaudiblewarning may be heard mall 0 et
pa its of the dwelling upon activation of a single device.
.
Access road and water supply meet I ocal fi re jurisdictional requirements. O 0
R325.4 Operable parts of door handles,pulls,latches,locks and other devices installed in AFH shall be operable with one hand
and shall not require tight grasping,pinching or twisting of the wrist(lever-type). a'-'
0
Pocket doors shall have graspable hardware available when in the closed or open position. 0
R311.8 Ramps YES NO
Inside Ramp N/A elf 0 0
R311.8.1 Maximum Slope one unit vertical in twelve units horizontal(8.3%slope).(Exception R311.8.1 Not allowed in AFH) 0 0
R311.8.2 Landing Requirements:min.3X3 foot landingattop/bottom,where doors open onto ramps,and where rampchanges
directions. 0 0
R325.9.1 Handrails required on both sides of ramp in accordancewith R311.8.3.1-R311.8.3.3. 0 0
Outside Ramp N/A 0 YESyNO
R311.8.1 Maximum Slope one unit vertical in twelve units horizontal(8.3%slope).(Exception R311.8.1 Not allowed in AFH) W0
R311.8.2 Landing Requirements:min.3X3 foot landing attop/bottom,where doors open onto ramps,and where ramp changes ei 0
directions.
R325.9.1 Handrails required on both sides of ramp in accordancewith R311.8.3.1-R311.8.3.3. Er 0
Guards below are depicted vertically as a n example only.All Ramps must have Guards 0' 0
Handrail both sides
---i I— Less than 4" / 34"-38"
T— flf�flf�- 1--,-r M
1 I it
I._ — ____ —_.---------_ -
Guard 1 1111111
36"minI I
1 I
1 11
-J . . . I 3'x 3'min
1 landing
3'x 3'min i _ �..�� ---�.��,�.�
landing — - -----
{
3' -- --1 --One unit vertical in twelve units horizontal r--3' -
minimum is an 8.3%slope all along surface of the ramp. minimum
R311.2 Means of Egress YES NO
R311.2 Door must be side-hinged with min.width of32 inches between face of door and stop.Height not less than 78 inches. .W 0
R325.4 Operable parts of door handles,pulls,latches,locks and other devices installed in AFH shall be operable with one hand
and shall not require tight grasping,pinching or twisting ofthe wrist(lever-type). I 0
R325.4 Required exit door hardware shall unlock inside and outside mechanisms when exitingthe building allowing re-entry Er 0
without use of key,tool or sp cial knowledge.
R311.7 Stairways N/A YES NO
R311.7.5.1 Riser Height:Max riser height shall be 7% inches(8 inches in structures built prior to July 1,2004) 8
R311.7.5.2 Tread Depth:Min.tread depth shall be in 10 inches(9 inches in structures built prior to July 1,2004)
8
R325.10.1 Handrails for Treads and Risers shall be installed on both sides of treads and risers numbering from one riser tom ultiple 0 0
risers.Handrails shall be installed in accordance with R311.7.8.1-R311.7.8.4
Effective:2013 July 01
Updated:2017 February
• , , .
NAME OF AFH: , 5'I�k x' loo -t* m.1, i✓ 0 04--E—
SECTION 5 MUSTBE COMPLETED BYTHE BUILDING DEPARTMENT IN TVE JURISDICTION THE HOME WILL BE LOCATED.
PLEASE CHECK ALL APPLICABLE BOXES; MATCH THE LIST BELOW TO THE APPLICANT'S FLOOR PLAN—USING THEIR PROSPECTIVE RESIDENT
BEDROOM DESIGNATIONS OF A B CD E AND F AND CLASSIFICATION CODE S,NS1 OR NS2.
SECTION 5 — BUILDING INSPECTOR'S INSPECTION CHECKLIST
R325.3 Sleeping Room Classification: Each sleeping room in an Adult family Home shall be classified as:
Type 5—where the means of egress contains stairs,elevators or platform lifts to evacuate residents to public area.
Type NS1—where 1 means of egress at grade level(has no stairs)or ramp constructed compliant with R325.9 is provided to evacuate residents to public area.
Type NS2—where 2 means of egress at grade level(both have no stairs)or ramps constructed compliant with R325.9 are provided to evacuate residents to public area.
SLEEPING ROOM A 0 Type S ,Type NS1 0 Type NS2 YES NO
Closet door/s are readily openablefrom the inside DYes 0 No Smoke al arm is installed in the bedroom B 0
Bedroom door opens easily and quickly from the outs ide when locked C 0
Sleeping room window has a net opening of 5.7 SF(minimum dimensions at least 24"high;at least 20"wide)
EXCEPT per R310.2.1:at-grade escape windows—may have net clearance opening 5 SF
Sleeping room window has a maximum sill height of 44"a bove fl oor to clear opening;no steps under window a Ilowec 0 P '
SLEEPING ROOM B L0 Type S ,Type NS1 0 Type NS2 YES NO
Closet door/s are readily openablefrom the inside 0[Yes No Smoke a I a rm is i nstalled in the bedroom {r 0
Bedroom door opens easily and quickly from the outside when locked 0 0
Sleeping room window has a net opening of 5.7 SF(minimum dimensions at least 24"high;at least 20"wide) a' 0
EXCEPT per R310.2.1:at-grade escapewindows—ma have net clearance opening 5SF
Sleeping room wi ndow has a maximum sill height 44' bovefloor to clear opening;no steps under windowallowec l ' D
SLEEPING ROOM C 0 Type S Type NS1 0 Type NS2 YES NO
Closet door/s are readily openable from the inside to Yes 0 No Smoke a farm is installed in the bedroom I ' 0
Bedroom door opens easily and quickly from the outside when locked IO 0
SI eepi ng room window has a net opening of 5.7SF(mi nimum dimensions at least 24"high;at least 20"wide) rif 0
EXCEPT per R310.2.1:at-grade escape windows—may have net clearance opening 5 SF
Sleeping room window has a maximum sill height of 44"above floor to clear opening;no steps under window a llowec 67 0
SLEEPING ROOM D 0 Type S Type NS1 0 Type NS2 YES NO
Closet door/s are readily openable from the inside 0 Yes 0 No Smoke a la rm is i nstalled in the bedroom 0 0
Bedroom door opens easily and quickly from the outside when Iocke0 0
Sleeping room window has a net opening of 5.7 SF(minimum dimensions atleast 24"high;at least 20"wide) 0 0
EXCEPT per R310.2.1:at-grade escape wi ndows—may have net clearance opening 5 SF
Sleeping room window has a maximum sill height o 44"above floor to clear opening;no steps under window a llowec 0 0
SLEEPING ROOM E �O Type S OType NS1 0 Type NS2 YES NO
Closet door/s are readily openablefrom th nside D Yes No Smoke a la rm is i nstalled in the bedroom 0 0
Bedroom door opens easily and quickly from the outside when locked 0 0
Sleeping room window has a net opening of 5.7 SF(minimum dimensions atleast 24"high;at least 20"wide) 0 0
EXCEPT per R310.2.1:at-grade escape windows—may have net cl earance opening 5 SF
Sleeping room window has a maximum sill height of 44"above fl oor to clear opening;no steps under window a Ilowec 0 0
SLEEPING ROOM F p0 Type S 0 Type NS1 0 Type NS2 YES NO
Closetdoor/s are readily openable from the inside DYes No Smoke alarm is installed in the bedroom 0 0
Bedroom door opens easily and quickly from the outside when locked 0 0
Sleeping room window has a net opening of5.7SF(minimum dimensions atleast 24"high;at least 20"wide) 0 0
EXCEPT per R310.2.1:at-grade escape wi ndows—may have net clearance opening 5 SF
Sleeping room window has a maximum sill height of 44"a bovefloor to clear opening;no steps under window a llowec 0 0
Effective:2013 July 01
Updated:2017 February
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minimum and 30 inches maximum
R325.8.3.1 Fixed position grab bars.Fixed position grab bars shall be a minimum of 36 inches in length and start 12 inches from
the rear w all.
R325.8.3.2 Swing-up grab bars.Swing-up grab bars shall be a minimum of 28 inches in length from the rear w all.
R325.8.4 Grab bars at bathtubs.Horizontal and vertical grab bars shall meet the requirements of R325.8.
R325.8.4.1 Vertical grab bars.Vertical grab bars shall be a minimum of 18 inches long and installed at the control end w all and
head end w all.Grab bars shall mount within 4 inches of the exterior of the bath tub edge or w ithin 4 inches within the bath tub. The
bottom end of the bar shall start betw een 36 inches and 42 inches above floor grade.
EXCEPTION:The required vertical grab bar can be substituted with a floorto ceiling grab bar meeting the
requirements of R325.8 at the control end and head end entry points.
R325.8.4.2 Horizontal grab bars.Horizontal grab bars shall be provided at the control end, head end, and the back wall w ithin the
bathtub area.Grab bars shall be mounted betw een 33 inches and 36 inches above floor grade. Control end and head end grab bars
shall be 24 inches minimum in length. Back w all grab bar shall be 36 inches minimum in length.
R325.8.5 Grab bars at shower stalls.Where shower stalls are provided to meet the requirements for bathing facilities, grab bars
shall meet the requirements of R325.8.
EXCEPTION: Shower stalls with permanent built-in seats are not required to have vertical or horizontal grab
bars at the seat end wall. A vertical floor to ceiling grab bar shall be installed within 4 inches of
the exterior of the shower aligned with the nose of the built-in seat.
R325.8.5.1 Vertical grab bars.Vertical grab bars shall be 18 inches minimum in length and installed at the control end w all and
head end w all.Vertical bars shall be mounted within 4 inches of the exterior of the shower stall or w ithin 4 inches inside the shower
stall. The bottom end of vertical bars mount betw een 36 inches and 42 inches above floor grade.
R325.8.5.2 Horizontal grab bars.Horizontal grab bars shall be installed on all sides of the shower stall mounted betty een 33
inches and 36 inches above the floor grade. Horizontal grab bars shall be a maximum of 6 inches from adjacent walls.Horizontal
grab bars shall not interfere with show er control valves.
R325.9 Ramps.All interior and exterior ramps, w hen provided, shall be constructed in accordance with Section R311.8 with a
maximum slope of 1 vertical to 12 horizontal. The exception to R311.8.1 is not allowed for adult family homes. Handrails shall be
installed in accordance with R325.9.1.
R325.9.1 Handrails for ramps.Handrails shall be installed on both sides of ramps between the slope of 1 vertical to 12 horizontal
and 1 vertical and 20 horizontal in accordance with R311.8.3.1 through R311.8.3.3.
R325.10 Stair treads and risers.Stair treads and risers shall be constructed in accordance with R311.7.5. Handrails shall be
installed in accordance with R325.10.1.
R325.10.1 Handrails for treads and risers.Handrails shall be installed on both sides of treads and risers numbering from one riser
to multiple risers. Handrails shall be installed in accordance with R311.7.8.1 through R311.7.8.4
R325.11 Shower stalls.Where provided to meet the requirements for bathing facilities, the minimum size of show er stalls for an
adult family home shall be 30 inches deep by 48 inches long.
[Statutory Authority:RCW 19.27.031 and chapters 19.27 and 34.05 RCW.13-04-068,§51-51-0325,filed 2/1/13,effective 7/1/13.Statutory
Authority:Chapter 19.27 RCW.10-18-036,§51-51-0325,filed 8/25/10,effective 9/25/10.Statutory Authority:RCW 19.27.190,19.27.020,and
chapters 19.27 and 34.05 RCW.09-04-023,§51-51-0325,filed 1/27/09,effective 7/1/10.Statutory Authority:RCW 19.27.074,19.27.020,and
chapters 19.27 and 34.05 RCW.07-01-090,§51-51-0325,filed 12/19/06,effective 7/1/07.Statutory Authority:RCW 19.27.031 and 19.27.074.04-
01-109,§51-51-0325,filed 12/17/03,effective 7/1/04.]
Effective:2013 July 01
Updated:2017 February
•
WAC 51-51-0325 -
Section R325—Adult family homes.
SECTION R325
ADULT FAMILY HOMES
R325.1 General.This section shall apply to all newly constructed adult family homes and all existing single family homes being
converted to adult family homes. This section shall not apply to those adult family homes licensed by the state of Washington
department of social and health services prior to July 1,2001.
R325.2 Reserved.
R325.3 Sleeping room classification.Each sleeping room in an adult family home shall be classified as:
1.Type S-Where the means of egress contains stairs,elevators or platform lifts.
2.Type NS1 -Where one means of egress is at grade level or a ramp constructed in accordance with R325.9 is provided.
3.Type NS2 -Where two means of egress are at grade level or ramps constructed in accordance with R325.9 are provided.
R325.4 Types of locking devices and door activation. All bedroom and bathroom doors shall be openable from the outside w hen
locked.
Every closet shall be readily openable from the inside.
Operable parts of door handles, pulls, latches, locks and other devices installed in adult family homes shall be operable with one
hand and shall not require tight grasping, pinching or twisting of the wrist.Pocket doors shall have graspable hardw are available
w hen in the closed or open position.
The force required to activate operable parts shall be 5.0 pounds (22.2 N) maximum Required exit doors shall have no additional
locking devices.
Required exit door hardw are shall unlock inside and outside mechanisms w hen exiting the building allowing reentry into the adult
family home without the use of a key, tool or special knowledge.
R325.5 Smoke and carbon monoxide alarm requirements.All adult family homes shall be equipped with smoke and carbon
monoxide alarms installed as required in Sections R314 and R315.1. Alarms shall be installed in such a manner so that the
detection device warning is audible from all areas of the dw elling upon activation of a single alarm.
R325.6 Escape windows and doors.Every sleeping room shall be provided with emergency escape and rescue windows as
required by Section R310. No alternatives to the sill height such as steps,raised platforms or other devices placed by the openings
w ill be approved as meeting this requirement.
R325.7 Are apparatus access roads and water s upply for fire protection.Adult family homes shall be served by fire apparatus
access roads and w ater supplies meeting the requirements of the local jurisdiction.
R325.8 Grab bar general requirements.Where facilities are designated for use by adult family home clients, grab bars for water
closets,bathtubs and shower stalls shall be installed according to this section.
R325.8.1 Grab bar cross section.Grab bars with a circular cross section shall have an outside diameter of 1 1/4 inches minimum
and 2 inches maximum Grab bars with noncircular cross section shall have a cross section dimension of 2 inches maximum and a
perimeter dimension of 4 inches minimum and 4 5/8 inches maximum
R325.8.2 Grab bar installation.Grab bars shall have a spacing of 1 1/2 inches between the wall and the bar.Ftojecting objects,
control valves and bathtub or show er stall enclosure features above, below and at the ends of the grab bar shall have a clear space
of 1 1/2 inches to the grab bar.
EXCEPTION: Swing-up grab bars shall not be required to meet the 1 1/2 inch spacing requirement
Grabs bars shall have a structural strength of 250 pounds applied at any point on the grab bar, fastener,mounting device or
supporting structural member. Grab bars shall not be supported directly by any residential grade fiberglass bathing or showering
unit. Acrylic bars found in bathing units shall be removed.
Fixed position grab bars,w hen mounted, shall not rotate, spin or move and have a graspable surfacefinish.
R325.8.3 Grab bars at water closets.Water closets shall have grab bars mounted on both sides. Grab bars can be a combination
of fixed position and swing-up bars.Grab bars shall meet the requirements of R325.8. Grab bars shall mount betw een 33 inches
and 36 inches above floor grade. Centerline distance betw een grab bars,regardless of type used, shall be betw een 25 inches
Effective:2013 July 01
Updated:2017 February
Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST
Code References:2015 IRC Section R325(WAC 51-51) f� l�
APPLICATION NUMBER:I7 /0 9 O J `
SECTIONS 1. 2. 3. AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED
SECTION 1 — PROPERTY INFORMATION
SITE ADDRESS: 39. 2 3 2'iT 4 T `6( W ASSESSORS TAX/PARCEL/4:E i 5"E
SECTION 2 — APPLICANT INFORMATION
rterCAS'ffji ` tAL-Ps rL 221 --2 +a
PROPERTYOWNERNAME: Ata � DAYTIME PHONE:
AFH LICENSEE NAME(IF DIFFERENT): 12:re---4' "Ll— Ot' i t-Y L 7DAYTIME PHONE: SA` t C
SECTION 3 — FLOOR PLAN
On a separate sheet of paper (8 1/2 x 11) draw a floor plan (including all
floors) of your prospective AFH. Include all sleeping rooms (bedrooms)
indicating which bedroom is: A, B, C D, E and F.
Label all components for exiting i.e.,stairs, ramps, platforms, lifts and
elevators.
SECTION 4— 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 that I am
requesting or I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home
at this location. I agree to hold harmless the jurisdiction conducting such inspections, at my request, as to any claim (including costs,
expenses, and attorneys' fees incurred in the investigation of such claim), which may be made by any person,including the undersigned,
and filed against the jurisdiction, but only where such claim arises out of the reliance of the jurisdiction, including its officers and
employees, upon the LA-G-
tof the information supplied
supplied to the jurisdiction as a part of this application. Q�
NAME/TITLE: 7L_._ 1T 4-06 tTI`e1 NL ( d (1\„.11.162, DATE: O Jl /)
PROPERTY OWNER EfAPPLICANT 'LICENSEE
(Effective July 1, 2013.)
Effective:2013 July 01
Updated:2017 February
CITY OF Building Division hhh
Fed era I Wa deral3332Eiy, Av9800e -632Sout5
� Federal Way,WA 98003-6325
Phone 253-835-2607 Fax 253-835-2609
CORRECTION NOTICE
ADDRESS: :3q 5. '3 PERMIT#: l 4 y
Ne' rY -h�
IF YOU HAVE QUESTIONS CALL (253) 835- W1—`1
WHEN CORRECTIONS HAVE BEEN MADE, CALL (253) 835-3050 FOR RE-INSPECTION. SEE BACK OF CARD
FOR DETAILS. NOTE: ELECTRICAL CORRECTIONS ARE REQUIRED TO BE MADE WITHIN 15 DAYS.
DATE INSPECTOR
DO NOT REMOVE THIS NOTICE
Page of
RECEIVED
A,A, PERMIT APPLICATION
CITY OF AUG 2 201 PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
Federal Way
CI7yOF 253-835-2607 + FAX 253-835-2609 +peimitcenter@cityoffederalway.com
DGOMMUN WAY
PERMIT NUMBER / 7_ /0 9 /�') .0 9'
is ./ _ J C
TARGET DATE Cs'..\...,,,_„")
SITE ADDRESS SUITE/UNIT#
3923 s 32-' --M q- . F LQ L 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ c 1 4-x- 3 p 0 - t 5 0
TYPE OF PERMIT {BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT tisi A. c ti-'LP -cid-
PROJECT DESCRIPTION I
Detailed description of work to
be included on this permit only
NAME .._ r PRIMARY PHONE_
-k. nSALC -- A. iwl .5 '2b -- 22( -=10 I
PROPERTY OWNER MAIL NG ADDRESS E-MAIL
-C1r� t0 4t, /-1--a, ck\)
CFITY�'lK •"K Y 7 STATE ZIP' 3
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
5/0)-3/7
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
E4.4kacte,- 01
PRIMARY PHONE .A
vvr ,t; A-z2C, I`� i E
APPLICANT- MAILING ADDRESS r-) V'c �., g E-MAIL
CITY
NAME PRIMARY PHONE
PROJECT CONTACT 9 t"Vm^JASI. co C ..
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING Er OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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: 1'1 DATE ,�/ 2:1 I -
�� ,111 ( i
PRINT NAME: -FC, L- ✓ 'l l 7 y Pe 4K1 N LDS OM
vJ
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offixture 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
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING I PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
Area in Construction #of
AREA DESCRIPTION Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING I
ADDITION I
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS 1111
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100 January 29,2016 Page 2 of 2 k:\Handouts\Permit Application