14-102529 • "Duilding - Single Family
City of Federal Way Permit #: 14-102529-00-S F
Community&Econ.con.Dev.Services
33325 8th Ave S
Federal Way,WA 98003
Ph:(253)835-2607 Fax (253)835-2609 Inspection Request Line: (253) 8355-30550
Project Name: GOLDEN DAYS ADULT FAMILY HOME
Project Address: 2715 SW 322ND ST Parcel Number: 873190 0210
Project Description: ALT-Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner Applicant Contractor Lender
PIOTR RAITER IANA LITVINOV
IANA LITVINOV 2715 SW 322ND ST
2715 SW 322ND ST 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
Additional Permit Information
New/Additional Sq.Feet-3rd Floor 0 New/Additional Sq.Feet-Basement 0
Mechanical to be Included? No Plumbing to be Included? No
No Fixtures Associated With This Permit !!
CONDITIONS:
Note: This inspection was already performed and passed,but State form was out of date. Follow up to
transfer data to correct form.
rl
PERMIT EXPIRES Saturday, November 29, 2014
Permit Issued on Monday, June 2, 2014
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: `= � U _ Date: 0 - a — /
Federal Way arERMIT (SAIF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES AP P L I C A N RECEIVED
253-835-2607•FAX 253-835-2609 ,
na_eu_ntgnt ede,gin,_lisoni ,,�
N 02 2014
SITE ADDRESS C MITLICASFICERAL WAY
..046 S 2,,7 C�r2ri ..G ( (n� CDS
PROJECT VALUATION ZONING ASSSESSOit�9 /PARCEL#
0 - F}
TYPE OF PERMIT 1 BUILDING CIPLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT �1' y �( FH-
(Tenant Name/Homeowner Last Name) . f�
N 1"' .-171JN F 'UT-A.., LT FA r-'( l 'I(;t-f E-_-- —
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER Rgal'AZ.c 7 d 49 3 `2
MAILING ADDRESS E-MAIL `7
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,<LO
CITY
U730-1j t,(� goa3
NAME PHONE
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NE:i2
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
NSTPHONE
APPLICANT MAILINGADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME,y /\' g PHONE
(The individual to receive and `�
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME a OWNER-FINANCED
Required value of$5.000 or more
IRCW 19.27-095) 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 plication.
SIGNATURE: ` DATE /F
PRINT NAME: P i o-I-rt
Bulletin#100—April 14,2010 Page 1 of 3 k:U-landouts\Permit Application