14-102015City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
a
FILE
Project Name: ABIATHER ADULT FAMILY HOME
Project Address: 2628 S 310TH ST
Aguilding - SiaglAFamily
Permit #: 14 -102015 -00 -SF
Inspection Request Line: (253) 835-3050
Parcel Number: 798440 0070
Project Description: ALT - Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner
Al2Rlican
Contractor
Lender
JACINTA KINUTIIIA
JACINTA KINUT RA
ABIATHER ADULT FAMILY
ABIATHER ADULT FAMILY
HOME
HOME
2628 S 310TH ST
2628 S 310TH ST
FEDERAL WAY WA 98032
FEDERAL WAY WA 98032
Census Category: 999 - Unknown
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:-
Floor
oadFloor Areas . ft. 0 0 0 0
Additional Permit Information.
New / Additional Sq. Feet - 3rd Floor....................0
Mechanical to be Included?...................................No
New / Additional Sq. Feet - Basement...................0
Plumbing to be Included?.......................................No
No Fixtures Associated With This Permit !i
PERMIT EXPIRES Saturday, November 1, 2014
Permit Issued on Monday, May 5, 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:A� Date:4s'. ,ibtl' 14-
FINALED,
City of Federal Way V
Certificate of Occupancy
This Certificate issued pursuant to the requirements of Secti' ion 1 'ole 11mational 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 byQdy staff.
Tenant Name: ABIATHER ADULT FAMILY HOME
Address: 2628 S 310TH ST
Permit #: 14102015 -00 -SF
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load
Floor Area (sq. ft.) 0 0 1 0 1 0
Owner Name: JACINTA KINUTHIA
JACINTA KINUTHIA
Owner Name: ABIATHER ADULT FAMILY HOME
Owner Address: 2628 S 314TH ST
FEDERAL WAY WA 98032
MRS
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 constnrction or use of said structure or the land upon
which itis situated. Such compliance is the responsibility of the owner and / or occupant of the premises.
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Federal Way CSF�CFPERMIT CO ME PL DE EN FP
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UNIYDEVEWPMENFSERVI Y o 2°XPPLICATION
-8352607• FAX 253-835-2609
win.L,nt�.�.ier�iu_,at� ra_r EpERAL WAY
CITY �F CDS
E ADDRESS
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SUITEMNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/FARCEL #
-7 __? 1 _` _y - v -7 -
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT/
2ant Name/Homeowner Last Name)
`
:OJECT DESCRIPTION
tailed description of work to
A w J\ v 0
CLCALLA A r" 1
included on this pennif only
PROPERTY OWNER
NAME _ �P1RDMART PHONE
Q D t �3 gra %j -D O a
MAII.WG ADISRESS iE-MAII.
Qsk I�.11er Sk• Su �� e. 1� o
_
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAT BUSINESS LICENSE #
NAME
CL C- Grnbv 1 ►k,vM Ct
PHONE
r,L (1,41 SZ -43
MAILDiG ADDRESS
D
E-MAIL
APPLICANT
CITY
ral wa
STATE
wa
IP
'q
qgo�3
FAX
PROJECT CONTACT
NAME
PHONE
?he individual to receive and
MAu"G ADDRESS
E-MAIL
espond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E-MAIL
PROJECT FINANCING
NAME
0 OWNER-MANCED
equired value of $5.000 or more
(RCW 19.27.09-19
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 owners 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 gficers and employees, upon the accuracy of the
information supplied to the as a part of this application.
SIGNATURE:
PRINT NAME: �Ta a (� � Ct 1/s � (yj J rA- L G,