14-102862City of Federal Way
Community & Econ. Dev. Services
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
#uilding - Single Tamily
Permit #: 14 -102862 -00 -SF
Inspection Request Line: (253) 835-3050
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Project Name: PEARL QUALITY ADULT FAMILY HOME
Project Address: 33011 27TH AVE SW
Parcel Number: 894520 0950
Project Description: ALT - Verification of Occupancy for Adult Family Home. ***No construction work
allowed under this permit.***
Owner
Applicant
Contractor
Lender
ALICE ONGAM
ALICE ONGAM
0
New / Additional Sq. Feet - 3rd Floor....................0
33001 30TH AVE SW
PEARL QUALITY ADULT FAMILY
0
Basic Plan?...........................................................
FEDERAL WAY WA 98023
HOME
0
New / Additional Sq. Feet - Garage.......................0
33011 27TH AVE SW
No
New / Additional Sq. Feet - Other ..........................0
FEDERAL WAY WA 98023
No
New / Additional Sq. Feet - Total ..........................
Census Category: 434 - Residential alt/add - no change in number of units
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Areas . ft. 0 0 0 0
No Fixtures Associated With This Permit 11
PERMIT EXPIRES Saturday, December 13, 2014
Permit Issued on Monday, June 16, 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: cx Date:
VO`N�'vEO
Additional Permit Information
New / Additional Sq. Feet - 1 st Floor ............:.......
0
New / Additional Sq. Feet - 2nd Floor ...................
0
New / Additional Sq. Feet - 3rd Floor....................0
New / Additional Sq. Feet - Basement ...................
0
Basic Plan?...........................................................
No
New/ Additional Sq. Feet - Deck ..........................
0
New / Additional Sq. Feet - Garage.......................0
Mechanical to be Included? ....................................
No
New / Additional Sq. Feet - Other ..........................0
Plumbing to be Included? .......................................
No
New / Additional Sq. Feet - Total ..........................
0
No Fixtures Associated With This Permit 11
PERMIT EXPIRES Saturday, December 13, 2014
Permit Issued on Monday, June 16, 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: cx Date:
VO`N�'vEO
CITY OF
Federal Way
R&W ' PERMIT APPLICATION
JUN 16 2014
PERMIT NUMBER C_
TARGET DATE
SITE ADDRESS / n
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL # _
- -C-) - O 0
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT�,�
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME _
I c� ice-. ( G
PRIMARY PHONE
'2x � _W 2_ d � 2 Q
MAILING ADDRESS
DDRESS1L_ I
,300( J
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�.
CIS
�
STATE
U//6
ZIPY C 2
2E-
,-�(
e6)VG�1fCW/G�/Vt,-(-
20
Zl�
NAMEE
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STAT NTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
TSTATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
E] OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRES ,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 application.
"
SIGNATURE: c�� - DATE O �0 t `1/
PRINT NAME: O ' " I L I C,
fl.
Bulletin 4 100 - January 1, 2013 Page 1 of 3 k:\Handouts\Permit Application