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12-101761t ♦ • S i � • • , --- a �. ; �---- Ouiiding o singiAdmi-3, w ' City of Federal Way community & Econ. Mv. Services Permit #: 1 2-1 01 761-00-S F 33325 8th Ave S Federal Way, WA 98003 Ph: (253) 835-2807 Fax (253) 835-2809 Inspection Request Line: (253) 835-3050 Project Name: COMFORT TOUCH ADULT FAMILY HOME Project Address: 32020 11TH AVE SW Parcel Number: 926493 0040 Project Description: ALT -Verification of Occupancy for Adult Family Home. ***No construction work allowed under this permit.*** Owner AR lip_ cant Contractor Lender MARIJANA MORROW ANTHONY SARUNI 17126 SE 29TH PL COMFORT TOUCH ADULT BELLEVUE WA 98008 FAMILY HOME 3202011TH AVE SW FEDERAL WAY WA 98023 Census Category: 434 - Residential altladd - no change in number of units Includes. #1 #2 #3 #4 Occupancy Class: Construction Occupancy Load Floor Areas . ft 0 1 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 ll PERMIT EXPIRES Wednesday, October 17, 2012 Permit Issued on Friday, April 20, 2012 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. ,�wrt�r or agent Date: ro, iN/uED a*ir/po APPUCA71 N! AMD IMSPECiltiril CHECKLIST - Adult ftndly Home t„� iidler+snoes: moff MP SMCMW WU CWAC a:•U) ►.�d/ �4 •-rJ: �'I ■.r 736E PL6-A-sc "t -6-1Z -70 )c".0,<- 1-*74A"V 61? -7He SAcK OF 7H/S P�IOOQ W sow I *Wft wwwr prww of ter ow the k*xf bn �.qy Ift is wo aad a rrgdtir a w of my bw**NIM OW east a am or 1 am awmwbwd by oro wmw Of ft Mq m R pm"Im fo rstma" I 'I d , for f of an Adrdt RoTx time at Urs locutlm t WMw OMW"E h" made #WOO= 1A ft t nattt Of SSW MW HMO Seniaea fOr Gh sdatt 60* hams tksmws 04 dW 1 have also made OPPOCa an b Oro 8XO1'P Ife Aaere* to aentMrct a Ch kWmW at 1* loegdon. I Avow agnea to hold hantdaas ea+ j�ptsdlellon Gordma" sw* moons, at aqr b (kmkimv coals, and suers' Am ft m, o in to hhvsftmdm of sud+ otst�n) wfrah mo be, , I m M =W and fiW SOOM @ $ft*ft ; tad G* wiaxs snob daft 1sa 1 vat of ttta mgwme of "oft"m. bmksm" ft fie ► of the Watl glia bow► on s ns of oris s~DR. NAMAIMM 13 1Ro1m,r o at APPLWAM K7 -00 ,eA rv4P a two Ajlr 1,Awd ®rr lAVE 9w - RECEIVED SEP 2.4 2012 C�j-� 7 �(" S 3 � Z CITY OF FEDFRAL WAY CDS 00 —?3:o 6 z NAME OF A SECTION 5 M T BE COMPLETED BY THE BUILDING DEPARTMENT IN THE JURISDICTION THE HOME ML BE LOCATED PLEASE CHECK ALL APPLICABLE BOXES; MATCH THE LIST BELOW TO THE APPLICANT'S FLOOR PLAN- USING THEIR PROSPECTIVE RgSIDENT BEDROOM DESIGNATIONS OFA. S. C. D. E. AND F AND CLASSIFICATION CODE: S, NS1, OR NS2 R325.3 SLEEPING ROOM CLASSIFICATION. Each sleeping room in an adult family home shall be classified as: Type S - where the means of egress contains stairs, elevators or platform lifts to evacuate residents to public area, Type NSI -where 1 means of egress at grade level (has no stairs), or a ramp constricted compliant with 8325.9 is provided to evacuate residents to public area. Type NS2-where 2 means of egress at grade level (both have no stairs), or ramps constnded compliant with 8325.9 are provided to evacuate residents to public area. SLEEPING ROOMS Sleeping Room A ❑ T11* S T NS1 ❑ T NS2 YES NO Closet doors are readily openable from the inside YEs 1140 ❑ Smoke alarm is Installed in the bedroom _ ❑ Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20" wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE WINDOWS—MAY HAVE NET CLEAR OPENING 5 SF ❑ Sleeping room window has a maximum sill height of 44" above floor, no steps under window permitted _ ❑ TypeS TypqNS1- NS2 YES ❑ NO Closet door/s are ready openaiblefrom theinside IyEso 13.1 Smoke alarm is installed in the bedroom ❑ Bedroom door is easily and quidldy-rrpenable from the outside when locked ❑ Sleeping room window,has a ast loaning of 5.7 s€* (tri in rnu -d es'ghs; at feast. 24" wgh: at leastT-w *EXXPTMR31f.Lj:A'r�LSCIIPEVE iOifi*�•-IMYHAVEWtOE�1Fti1✓:'ENNa 'SF ❑ Steeping room window has a mwnum sift height of 44" above floor; no steps reviler window permitted - ❑ Sleeping Room C ❑ Type S Type NSI ❑ T NS2 YES NO Closet doors are readily openable from the inside I YEs Ik I No ❑ I Smoke_ alarm is installed in the bedroom ❑ Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20" wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE w9NDm —wy HAVE NET CLEAR OPEMM 5 Sr_ 19 ❑ Sleeping room window has a maximum sill height of 44" above floor; no steps u r window permitted 11 Closet door/s are readily c pdm*e"bom InWe❑ Smoke alarm is installed in the bedroom N0 El Bedroom door is easily and quickly 2pertable from the outstdevtten ioickatf _ ❑ Sleeping room windoW-has a net opening of 5.7 S€* mini iv 4* h n' a t st z go *EXCfPTPErtt2$'t## 1.9.J4T� PEts�AiAY HAVEt1ETGF�AR�li3�'$€ ❑ .Sleeping room wi!Lw r has'", ptaxll%lm-SPJ #eight of 44" above r, llto t rir w-1 d Sleeping Room E _ _ ❑ T S T NS1 L7 T NS2 YES ] NO Closet door/s are readily openable from the inside YEs ryp" ❑ Smpke Ott is -info ljt"It - _ " Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20" wide) *EXCEPT PER 8310.1.1: AT -GRADE ESCAPE WINDOWS —MAY HAVE NET CLEAR OPENING 5 SF [] Sleeping room window has a maximum sill height of 44" above floor; no steps under window permitted ❑ hf " Q I NS2 YES NO Closet dooris are reaklffyrV_P We'lnside Yes .❑ Smoke alarm is installed in the bedroom ❑ Bedroom door is easity and qutoMy-,oponable from the outside wtleft locked" Sleeping room window has -a nE1 opening of S.7 s€* (mift1ir11at M, Alob:* _, *EXCEPTPERR3f" ❑ Sleeping room window has a maximum sill height of 44" above Roar;- ni -s$eps under window permit# :; "_ _...- :: °_, .- :_: ❑ UtNtKAL NO Bathroom doors are easily and quickly openable from the outside when locked ❑ Smoke alarms are installed on 611 levels of t ewe in , in eac resident sleeping room, outside eachsepara e sleeping fij area in the immediate vicinity of sleeping rooms (83 14) Smoke alarms are installed in succi a manner so that - the fire warning may be audible in all parts of the dwelling upon ❑ activation of a single device. Access road and water supply meet local fire jurisdictional requirements .0 ❑ 08101/10 11� _ YIES_ Ind Rama YES NO R311.8.1 Maximum Slope one unit vertical in twelve units horizontal 8.3% slope), (Exception R311.8.1 Not allowed in AFH ❑ ❑ R3.2«Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where ramp changes directions. ❑ ❑ R325.9.1 Handrails required on both sides of ramp in accordance with R311.8.3.1— R311.8.3.3. ❑ ❑ MW YES NO R311.8.1 Maximum Slope one unit vertical in twelve units horizontal 8.3% sio (Exception R311.8.1 Not allowed in AFH W.10.04** for Traods and =T9X6ghm-brafterto ❑ R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where ramp Ott es directions. ,' ❑ R325.9.1 Handraits required on both sides of ramp in accordance with R31'1.8.3.1-- R311.8.3.3. 8325.8 Grab bars shall be installed for all water closets (toilets), bathtubs and showers. ❑ I ADULT FAMILY HOME RAMP per 2009 IRC with WA. ST. AMENDMENTS *ALL RAMPS REQUIRE A BUILDING PERMIT* &311.2 Means of Earm YIES_ W R311.2 Door must be side -hinged with min. width of 32 inches between face of door and stop. Height not less than 78 inures. !a 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, emergency egress hardware). The Exit doors shall have no additional locking devices. ❑ "I.7.4.1 ftw - ' Max riser shaft the ids bt etntt ures lit to 1. Z1Jf34 $bft@#I;*1n-0yd:uW July 1. 2M 0- -0- 13 t11.T4 2 Tread Deplft.Min. tread th s #ore - roes in'st€rres lam, t� �l 1 2{l04 RSI 1.7 W.10.04** for Traods and =T9X6ghm-brafterto R 45.8 Grab Bars in Bathrooms fty Leguire °altemate' gpyovall in accordance with IRC Sec. R104.10 anL111 YES NO 8325.8 Grab bars shall be installed for all water closets (toilets), bathtubs and showers. Bathing facilities such as tubs and showers; and ❑ On both sides of the toilet. shall comoy with ICC/ANSI Al 17.1 Sections 604.5,607.4 & 608.3 3 ' t 05 E ft 1" - -YES ❑ i AGIOU Must be swounded by a barrier that Is 48 Inches No, may have doors and or gates that must have audible ataftswben A6*113.5.5 OPTION. Pools, Spas or hot tubs with a= ft cover WOL6 ggplies, with ASTM F 1346 � Q PASSE CORRECTIONS REQUIRED PERMIT REQUIRED OIL- WIF PECTOR'S GNATURE: DATE: ZS -3 ?54- X07 INSPECTOR'S ADDR S: PHONE: 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. 08/01/10 C It %Lit Famn-Y H�m (AFH) LocAL wnDnw msPE-cnoN amamm Code Refwwxas. 2M IRC SeCtkn R325 (WAC 51-51) • APPLIECATION MUNSM' A?, 0 7-nq '-7SEcTum 1, 2,3, Am 4 LM sE gggl= W AMMM MWORE MSPECTM WILL BE PROC83SED srrEAwREss:12010 11-TH A06' f -AV PSSESSMSTMMML#: ------------ PROPERTY OWNER Nk*: MAIZilMA m. mag."&4 DAYTME PHONE: AFHLxEmsEFmAmE(roymmm.-Ar4-rYA44Y 4AA-Wil DAyrm mm: APPLMAM MW MAW COMMM FLOOR PLJ4A/S ON 7M FORM (MJL FLOGM). PLMU DMUM M.L UMPM ROOM (MMOOM). ON 7MS DRAMM IN DrATE WHICH BE is & B. C. D. L my F. Lmsa ALL cpmpomms Fog ExmmG Le.: STAIRS, RAMPS, KATFORM LIM & EUWATM. I caffy under pamft of perjury that ft k0onneem harmihed by im is bm and Cala ft ft bW d ow WoOmop, mW 00 1 am m*m0V*--w I am auffmdud by the owner of the above preffftm to request hmpec*m fm ft upwWm d as 044 Fm*-Hom as Oft Weaftm I spie M fWd hwnftu V* oWftfim cm&ic*V such ftpecftmw my requmt, as to my daim (umki&V casK expw*ms, mW aawnrp'few WmuW In the invest WWon of such claire;. which nsaq b nada b y person, inckx*v the undue, and ftd,sqR*W the p, Rist but a* where such cairn Wmm out d the reewme Wcas and MR00yea, tqm Me apawacy d ft wdamoftn supplied to the Oisdk*m as a pwt of this DAM 0 FMNRW OWMElt it AVMMAXT 0 LKU*M M01110 4 ,'NSt IIX HSI Akst L I 4f /-A Asssem,54Y A g -6A I caffy under pamft of perjury that ft k0onneem harmihed by im is bm and Cala ft ft bW d ow WoOmop, mW 00 1 am m*m0V*--w I am auffmdud by the owner of the above preffftm to request hmpec*m fm ft upwWm d as 044 Fm*-Hom as Oft Weaftm I spie M fWd hwnftu V* oWftfim cm&ic*V such ftpecftmw my requmt, as to my daim (umki&V casK expw*ms, mW aawnrp'few WmuW In the invest WWon of such claire;. which nsaq b nada b y person, inckx*v the undue, and ftd,sqR*W the p, Rist but a* where such cairn Wmm out d the reewme Wcas and MR00yea, tqm Me apawacy d ft wdamoftn supplied to the Oisdk*m as a pwt of this DAM 0 FMNRW OWMElt it AVMMAXT 0 LKU*M M01110 Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST Code References: 2009 IRC Section 8325 (WAC 51-51) /w? /�� APPLICATION NUMBER: SECTIONS 1 213 AND 4 T1 E ED NX &MIM BEFORE INSPECTION WILL BE PROCESSED �7 N47 irll / l ?L; C«W l GyL+"�+ L✓t� Y qS® ASSESSORS TANPARCEL*: SCFE ADDRESS: PROPERTY OWNER NAME: MA21 �f ArJA rel n� (7 22.0 i..! -- DAYTIME PHONE: i 0 6 - 40 -� AFH LICENSEE NAME (r wmtE rq: A r 4 rk0I� y S A R -Ll l r DAYTIME PHONE: 7-53 - TIC- 9 9 rV le4 Li v� we ALoox /I? ix 2-4 r 13A 04 LAW14 � wyXJy 1bz41Si A_C,S&M6 4Y AeA 1 certify under panaity of perjury that the information tumisihed by me is true and correct to the best of my knowledge, and that i am nxWesting or 1 am authorized by the owner of the above premises to request inspection for the operation d an Adult Family Home at tins location. 1 ag;'se to hold howdess the jurisdiction conducting such inspections, at my request, as to any claim (including costs, expenses, and attomeys, fees it wred in the investigation d such claim), which may ads b y person, including the undersigned, and filed against the jurisdiction, but only where such claim arises out of the reliance of the ng its officers and employees, upon the accuracy of the information suppked to the jurisdiction as a part of this appkcati l ' NAME/TDATE: «. ITLE: pp�� ❑ PROPERTY OWNER t9L APPUCANT ❑ 13Cii9ISVE 0101110 NAME OF AFH; SECTION 5 MUST BE COMPLETED BY THE BUILDING DEPARTMENT IN THE JURISDICTION THE HOME WILLAE 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. C. D. E. AND F AND CLASSIFICATION CODE: S. NSI, OR NS2 025.3 SLEEPING ROOM CLASSIFICATION. Each sleeping room In an adult family home shall be classified as: Type S — 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 a ramp constructed compliant with 8325.9 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 8325.9 are provided to evacuate residents to public area CI FFPINP. Rnnm-q Sleeping Room A 1 ❑ R"Type NS1 I ❑ Type NS2 YES NO Closet door/s are readily openable from the inside I YES 2 NO ❑ Smoke alarm is installed in the bedroom R** Bedroom door is easily and quickly openable from the outside when locked Er ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20' wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE WINDOWS -MAY HAVE NET CLEAR OPENING 5 OF Sleeping room window has a ma)dmum sill height of 44" above floor, no steps under windowpermifted ❑ Sleeping Room B 1 ❑ Tvpe S ff Type NS1 ❑ Type NS2 YES NO Closet doorls are readily openable from the inside I YES UVT NO ❑ I Smoke alarm is installed in the bedroom Fel' ❑ Bedroom door is easily and quickly openable from the outside when locked Sleeping room window, has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20" wide)Er *EXCEPT PER R=.1.1: AT -GRADE ESCAPE wwoows-MAY HAVE NET CLEAR OPENING 5 OF I Sleeping room window has a maximum sill height of 44" above floor, no steps under window pe ! ed ❑ Sleeping Room C 1 ❑ TM S [3Type NS1 ❑ Type NS2 YES NO Closet door/s are readily openable from the inside YEs NO ❑ I Smoke alarm is installed in the bedroom R, ❑ Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20' wide) *ExcEPT PER R310.1.1: AT -GRADE ESCAPE WINDOWS -MAY HAVE NET CLEAR OPENING 5 OF ❑ Sleeping room window has a maximum sill height of 44" above floor; no steps and r window permitted ❑ Sleeping Room D Ij Type S [N'Type NSI ❑ Type NS2 YES I NO Closet doorls are readily openable from the inside YES EY1 No ❑ 1 Smoke alarm is installed in the bedroom ❑ Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24' high: at least 20' wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE WINDOWS -MAY HAVE NET CLEAR OPENING 5 OF ❑ Sleeping room window has a maximum sill height of 44' above floor, no steps un window permitted Rol ❑ Sleeping Room E 1 ❑ Type S 91 Type NSI 1 ❑ Type NS2 YES I NO Closet doorls are readily openable from the inside YES NO ❑ 1 Smoke alarm is installed in the bedroom ❑ Bedroom door is easily and quickly openable from the outside when locked ❑ Sleeping room window has a net opening of 5.7 SF* (minimum dimensions at least 24" high: at least 20' wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE WINDOWS -MAY HAVE NET CLEAR OPENING 5 OF ❑ Sleeping room window has a maximum sill height of 44' above floor; no steps under window permitted ❑ Sleeping Room F ❑ T e SIType NSI ❑ Type NS2 YES I NO Closet doorls are readily openable from the inside I YES NO ❑ Smoke alarm is installed in the bedroom ❑ Bedroom door is easily and quickly openable from the outside when lacked ❑ Sleeping room window has a net opening of 5.7 sF* (minimum dimensions at least 24' high: at least 20' wide) *EXCEPT PER R310.1.1: AT -GRADE ESCAPE WNDOws-MAY HAVE NET CLEAR OPENING 5 OF ❑ Sleeping room window has a maximum sill height of 44" above floor, no steps under window permitted ❑ GENERAL YES . NO Bathroom doors are easily and quickly openable from the outside when locked UK ElSmoke alarms are installed on a levels o the we In, In each seepingroom, outside each area in the immediate viciniof sleeping rooms R3 ❑ Smoke alarms are installed in such a manner so that the tire warning may be audible in all parts of the dwelling upon activation of a single device. Access road and water supply meet local fire jurisdictional requirements ❑ 08101/10 t s #A f R3111 Rarnipg Inside Ram V I N/A -(ESj NO R311.8.1 Maximum SVe one unit vertical in twelve units horizontal 8.3% slope). (Exception R311.8.1 Not allowed in AFH ❑ El R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where ramp ❑ chan es directions. R325.9.1 Handrails required on both sides of ramp in accordance with R311.8.3.1— R311.8.3.3. ❑ ❑ R311.8.1 Maximum Slope one unit vertical in twelve units horizontal 8.3% slope). Exce tion 8311.8.1 Not allowed in AFH ❑ R311.8.2 Landing Requirements: min. 3X3 foot landing at top/bottom, where doors open onto ramps, and where ramp CE]chan es directions. R325.9.1 Handrails required on both sides of ramp in accordance with 8311.8.3.1-R311.8.3.3. *Guards below are depicted vertically as an example only. All Ramps must have Guards Less than 4" wimum 10N � 1111 ` "a'" MINIM �rw+f rrl���loll l� � � ( Int■�[� , 1�f�;IMi�1:� 1111 MIItMl1�: _ I L3'x 3' min landing 1:12 max slope 3 8.3% min ADULT FAMI' Y HOME RAMP per 2009 IRC with WA. ST. AME1 DMENTS *ALL RAMPS REQUIRE A BUILDING PERMIT* 3' x 3' min landing min YES I NO R311.2 Door must be side -hinged with min. width of 32 inches between face of door and stop. Height not less than 78 inches. ❑ 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, emergency egress hardware). The EA doors ❑ shall have no additional locking devices. 11.7 StalnyMLs I W YES NO R311.7.4.1 Riser Height Max riser height shall be 4 inc es 8 inches in structures built prior to July 1, 2004 ❑ ❑ R311.7.4.2 Tread Dep th: Min. tread de th shall be 10 inches. 9 inches in structures built prior to July 1, 2004 ❑ ❑ R325.10.1 Handrails forTreads and Risers shall be instaged on both sides of treads and risers numbering from one riser to ❑ ❑ multiple risers. Handrallls shall be installed in accordance with R311.7.7.1- R311.7.7.4 R 325.8 Grab Bars in Bathrooms (May require °alternate° approval in accordance with IRC Sec. R104.10 and .11) YES NO R328.8 Grab bars shall be installed for all water closets (toilets), bathtubs and showers. Bathing facilities such as tubs and showers; and On both sides of the toilet. shall comply with ICC/ANSI Al 17.1 Sections 604.5,607.4 & 608.3 AG103 - AG 105 Swimming Pool, Spa, Hot Tub I WAI , AG1052Mtb nA db b ' 4 EI U. s surrou e y a amer that Is 8 Inches high, may have doors and or gates that must have audible ❑ ❑ alarms when opened. A094 5 EXCEPTION: Pools, Spas or hot !qLs with a safety cover which complies with ASTM F 1346 El El,�,�� P ED CORRECTIONS REQUIRED L7 PERMIT REQUIRED Z;0, 9-.;28'-1z INSPECT R'S SIGNA E: DATE: Ql Gx- ?-y3 -.S'3 -.24"ez INSPECTOR'S ADDRESS: PHONE: 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. 08101/10 �,oeCtVPJkMIT CommUNfI]'AEVELt1PMEWSERVICES A,�*"LICATION 20S,,t5.2607• FAX 2W-895 2W9 Y —.f Tv OF fEj)ERAL\vl� SITE ADDRESS PRo.racT vAurATcoN TYPE OF PERMIT NAME OF PROJECT (fenant Name/Honwoumer Last �7�-1 SF MF CO ME PL EN FP a, ()-7 Surm/Umm # t) k WA I KOXI 1 t t Fav a So z� w ZONING ASi�tE88 3 TAZ/1'ARCEL M BUII DING ❑ PLUM SING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINI�.ERiNG ❑FIRE SON ev . 1,n. , t u "Lt 4_"i `-A m i 1,->) �~}pMt�woommam PROJECT DESCRIPTION CA9-E IDI-� Detailed description of work to be included on this permit only S -1 PROPERTY OWNER PROJECT CONTACT (17de in"idual to recek w and respond to aA correspondence concerning this appltcatkwO NAPE MAD Il'M ADDRESS crff SAM nrAtQ.rnG ADDRF� M - �oRRa�3 aR Is V Vi W f'o©: . :y I txlT 'WA STAT'& COFACTOR'S LiCEmwE � 7 ARx rnami (O - I -2T -3 P00= FIBLV • FAX FXpMATM DATE FEDERAL FIAT vuSvHM Lumma # ! f xrAD,ntGADDieFss �� G�QYLt✓Li .. Kotmo l Av�� 231P FAX ciT'r E IQ ©Qt3 PROW E•.wuL MA9.0G ADDRESS FAX STATE Zw y oK-c. LA) M �JA� �igo'�-3 AT TF.RTfm CONTACT NAhm PROJECT FINANCING NOW P+' %4 + Required value of $5.000 or more mAnj NG, ADDRESS. CPt7. $TATE. « g PSONE� (WW 79.27.095) best that T am the pnvparty maser or �o� alter of the PrOP" and correct- I °r'� I to the that P U iil «►roFlj I cerno ledger t�t11�� omitted in support of this permit application is � issuance c!f a P�iH. jr understand that the all applicable of pagsrai Way reSui gaining to the worlcc � � state, or federoi tm»s regulating goes not remooe the owner's issuance 4f this Pmses, and attorneys'fees incarred in I°D or � less the [ 4f j°� Way � to argl elatm caste. S►dy�, d jU d against the city. a such clab,,L which may be made try any peraodM the accuracy of the the b gation and delfense i the reliance of the city, bwjuding its o.,�� and "tPlOP"s, uP°f1 but wft urhem such dairn arises i4ormation supplied to the city as a ' n DATE SIGNATURE- r>.vreiT AAMR! i Fbr1`iAcRL►+-1 - -F- page i of 3 k.+HandoutsNrelTlun rye„ Rntlrtin #100 - Avril lA, 2010