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17-101512Building - Single Family City of Federal Way Community Development DepL Permit #:17 -101512 -00 -SF 33325 8th Ave S Federal Way, WA 98003 Inspection Request Line: (253) 835-3050 Ph: (253) 835-2607 Fax: (253) 835-2609 Project Name: DO WON ADULT FAMILY HOME Project Address: 812 S MARINE HILLS WAY Parcel Number: 515293 0130 Project Description: ALT - Inspection only of Adult Family Home. No construction approved on this permit. Owner Applicant Contractor ender JI WOO KIM DO WON ADULT FAMILY HOME 812 S MARINE HILLS WAY 812 S MARINE HILLS WAY FEDERAL WAY WA 98001 FEDERAL WAY WA 98001 Census Category: w �r Includes: #1 #2 Occupancy Class: Construction Type: Occupancy Load: Floor Area (sq. ft.) Add ' alI ation Mechanical to be Included? ..................................... No an T.C. application?.................. Yes Plumbing to be Included? ........................................ o • PE I hereby certify and the occ ora lik— 19F dw M-Y� 30 September, 2017 on nday, April 3, 2017 ,ect and that the construction on the above described property cordance with the laws, rules and regulations of the State of and the City of Federal Way. eow- Date: ./ zed% CITY OF Building Division Federal Way Phone 233325 Eighth Avenue South Federal Way, WA 98003-6325 53-835-2607 Fax 253-835-2609 CORRECTION NOTICE IF YOU HAVE QUESTIONS CALL nd (253) 835 - 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. N)5 #90 DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page of ADDRESS: Z c(65 GC 1 ne16i- L101 laoLJ5 a ERMIT#: =)015' ""3'rAfww\5 514aiI Z �� 7s� wI'd e x l y -fes) I IMM _6 i MAM _ f? d rocm 5 I ,t✓ ✓lo -r J e - P 42411 - Z. -_�r'7\ZL 3..5, i -t — Door lnarcAW -m be_ )eye,(- 5-hde_ Or- ai j bejrae, 618 tasaOe_ ba-t�,Cmhs 3 • TQC. in2(.�a 3)6-q- 5ren5 w CX;,Y i -901 'tt ua (6(- 6M . 4- WeLl 2 sl a )1 L4,11 10Ck c— ±On) , 0 r - 6'.A Qw5 j e kJa e, -rL, cn.,��►o�c-�r - +0;1 e+s ,-}-,..bs . sl�,wecs (� � 2�-� ► nS(}P rAi o n Cev-\ S✓vtolCe akcmS aylA ri) 2- o\ka`wIS are- 1-i r -c W; (- 44 ���i��✓1Q (, �� i�nZ D.)A(mS laic ,tom fJCd /cc_A "00-)5 _4A �� L 3 )I g , — I-}c,r� Ccs► )5 ©✓� 5 ► r 6,fween 3 �1 '' and .39r' ` ✓yidf Cocte&tto(\5 ,MAkr �0110w a -j- ✓IeX-j "'I:ip. IF YOU HAVE QUESTIONS CALL nd (253) 835 - 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. N)5 #90 DATE INSPECTOR DO NOT REMOVE THIS NOTICE Page of Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST Code References: 2M IRC Section R325 (WAC 51.51) APPLICATION NUMBER: LZ -I 0 SECTIONS 1. 2. 3. AND 4 MUST BE COMPLETED By APPLICANT BEFORE INSPECTION WILL BE PROCESSED SECTION 1 —PROPERTY INFORMATION SITEADDRESS: -P/3- PROPERTY OWNER NAME: /C jm�, i lifer TAX/PARCEL#;, _ DAYTIME PHONE: %5 '35, 7- AFH LICENSEE NAME (IF DIFFERENT): E/6 10 V6 /Y I+ t DAYTIME PHONE: /(.(/!o "e-5 V - 622S SECTION 3 — FLOOR PLAN On a separate sheet of paper (8 1/2x ii) 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 componentsforexiting i.e., stairs, ramps, platforms, lifts and elevators. I 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 accuracy of the information suppjied to the jurisdiction as a part of this application. NAM E/TITLE: OWNER (Effective July 1, 2013.) __b LICENSEE DATE: Effective: 2013 July 01 Updated: 2017 February NAME OF AFH: SECTION 5MUSTBECOMPLETEDBYTHEBUILDINOUEPAKIMtNI IN IHt3l7K1:�UiL"Un IntnvmtvvIu.PCwvaiw. PLEASE CHECK ALLAPPLICABLE 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•''S INSPECTION R325.3 Sleeping Room Classification. Each sleeping roan in an Adult family Home shad ne aassmea as: Type S — where the means of egress contains stayss, elevators or platform lifts to evacuate residents to public area. Type NSI — where i means of egress at grade level (has no stairs) or ramp constructed compient with 6325.9 is provided to evacuate residents to public area. Type NS2 — where 2 means of egress at grade level (bods have no stairs) or ramps constructed compliant with 8325.9 are provided to evacuate residents to public area. SLEEPING ROOM A I E3 Type S 113 Type NSi 113 Type NS2 YES NO Closet door/s are readily openable from the inside Yes 113No I Smokealarm is installed in the bedroom 0 0 Bedroom door opens easily and quiddyfrom the outside when I ocked 13 ff Sleeping roomwindowhasanetopeningof5.7SF(minimumdimensionsatIeast24"high; at least2(r Wide) EXCEPT per R310.2.1: at -grade escape wi ndows -may have net clearance opening 5 SF 0 0 Sleeping room windowhasamaximumsill height of44"abovefloortoclearopening; no ss under Window allov&K013 SLEEPING ROOM B Type S Type NSi 10 Type NS2 YES NO Closet door/sare readl o enable from the inside Yes No Smoke alarm is installed in the bedroom 0 Bedroom door opens easiland uidd from the outside when Iocked 0 Sleeping room windowhas anetopeningofS.TSF(minimum dimensions atleast24"Ngh;atleast2("Wide) EXCEPT per R310.2.1: at -grade escape wi ndows - may have net clearance opening 5 SF 0 0 room window has a maximum sill hei htof44"abovefloortoclearopening; no ssunder window all -Sleeping SLEEPING ROOM C I L3 Type S lE3TVpeNS1 JU Type NS2 YES NO Closet doors are readily o ablefromtheinside DYes ONo Smoke alarm isiristalledinthebedroom 0 0 door opens easil and quickly from theoutsidewhen Iodted -Bedroom Sleepingroomwindowhasa netopeningof 5.7SF (mi nimurn dimensions at least 24"high; at least 2(" wide) EXCEPT per R310.2.1: at -grade escape wi ndovis-may have net clearance opening 5 SF 0 0 roomwindowhasa maximurnsill heightof44"abovefloortoclearopening; no ssunder wipdowall -Sleeping SLEEPING ROOM D I L3 Type S 113 Type NSi Type NS2 YES NO Closet door/s are readilyo enable from the inside Yes No I Smoke alaM nstalledinthebedroom 0 0 Bedroom door opens easlyand quicklyfrom the outside when Iodted 0 0 Sl eepi ng room window has a net opening of 5.7 SF (mi nimum dimensions atl 24"high; atIeast 20"wide) EXCEPT per R310.2.1:at-grade escape windows -may have net cleara pening5SF 0 0 room window has a maximum sill height of 44" a bovefl to clear opening; no steps under window allowec -Sleeping SLEEPING ROOM E Type S 10 Type NSl ILI Type NS2 YES NO Closet door/s are readilyo enablefromtheinside es No Smokealarm is installed in the bedroom E30 Bedroom door opens easily and quiddyfromthe tsidewhenlocked Sleepingroom windowhas a net opening of %(minimumdimensiorsatleast24"high; at least 20" wide) EXCEPT per R310.2.1:at-grade escape ova -may have net clearance opening 5SF 0 0 SI ee i ng room window has a max1p6n sill height of 44!a bove floor to clear opening; no steps under window a Ilow SLEE G ROOM F Type S 10 Type NS2 JE3 Type NS2 YES NO Closetdoor/s are reacilenablefromtheinside Yes No I Smokealarm is installed in the bedroom Bedroom door op silyaridquiddyfromtheoutsidewhenIocked Sleeping roan owhasanetopeningof5.7SF(minimumdimensions atleast 24"high; at least20"wide) EXCEPTper 10.2.1: at -grade escape windows -may have net clearance opening 5SF 0 0 Sl eepiog room windowhas amaximum sill height of44"abovefloortoclearopening; nos sunder windowallaw Effective: 2013 July 01 Updated: 2017 February GENERAL YES I NO. - Bathroom doors are easily and quickly o enablefromtheoutsidewhenlocked 13 0 Carbon MonoxidealarmsareinstalledasrequiredinR315oneachlevelofthe home. 0 0 Smoke alarms are I nstalledon all levels of the dwel I ing, in each resident sleeping room, outside each separate s I eepi ng area In the i mmediate vi dnity of s leepirig rooms ( 8314). 0 Q SmokeandCarbon Monolddealarmsare installed insuchamanner sothattheaudiblewamingmay beheardinall parts of the dwelling upon activation of a single device. 0 0 Access road and water supply meet localfi rejurisdictional requirements. YES NO 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 ortwistngofthe wrist (lever -type). 0 0 Pocket doors shall have graspable hardware available when in the closed or open position. Q a 8311.8 Ramps YES NO Inside Ramp I N/A 131 Q Q R311.8.1 Maximum Slope one unit vertical in twelve units horizontal (8.3% slope). (Exception R311.81 Not allowed in AFH) 11311.7 Stairways I N/A E3 I I R311.8.2 Landing Requirements: min. 3X3 foot landing attop/bottom, where doors open onto ramps and where rampchanges directions. 0 E3 8325.9.1 Handrails required on both sides of ramp in accordancewith 8311.8.3.1—R311.8.3.3. _Pj 13 R325.10.1 Handrails for Treads and Risers shall be installed on both sides oftreads and risers numbering from one riser to multiple risers. Handrails shall be installed in accordance with 8311.7.81—R311.7.8.4 outside Ramp I N/A 0 1 YES NO 8311.8.1 Maximum Slope one unit vertical in twelve units horizontal (8.3%slope). (Exception R311.81 Not allowed in AFH R311.8.2 Landing Requirements: min. 3X3 foot landingattop/bottom, where doorsopen onto ramps, and where rampchanges directions. Q a 8325.9.1 Handrails required on both sides of ramp in accordancewith R311.83.1—R311.8.3.3. 0 Guards bel ow a re depicted vertical as an exam le on I . AN Ramps must have Guards Guard 36" min L minimum Handrail both sides 34" - 38" One unit vertical in twelve units horizontal is an 8.3% slope all along surface of the ramp. . 3' minimum R311.2 Means of Egress YESNO 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 hard and shall not require tight grasping, pinching or twisting of the wrist (lever -type). 130 R325.4 Required exit door hardware shag unlock inside and outside mechanisms when exiting the building allowing re -entry without use of key, tool or special knowledge. 11311.7 Stairways I N/A E3 I I 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) R311.7.5.2 Tread Depth: Min. tread depth shag be in 10 inches (9 inches in structures built priortoJuly 1, 2004) _Pj 13 R325.10.1 Handrails for Treads and Risers shall be installed on both sides oftreads and risers numbering from one riser to multiple risers. Handrails shall be installed in accordance with 8311.7.81—R311.7.8.4 E3 0 Effective: 2013 July 01 Updated: 2017 February R325.8 Grab Bars in Bathrooms I N/A 131 YES NO Grab bars shall be installed for all water closets (toilets), bathtubs and showersaccordingto R325.8. Water Closets (toilet)shall have grab bars installed on both sides according to R325.8—R325.8.3.1 or R325.83.2. 0 Q Bathtubs shall have two vertical and three horizontal grab bars installed accordingto R325.8-R325.8.4—R325.8.4.2 Shower stalls have two vertical and horizontal grab bars mounted on all sides of shower accordingto R325.8—R325.8.5— 0 R325.8.5.2. Showerstalls must be minimum size of 30 inches deep by48 inches long (R325.11) AG203—AG105Swimming 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 Q opened. AG105.5 EXCEPTION: Pools, Spas or Hot Tubs with a safety cover which complies with ASTM F 1346 Q PASSED Q CORRECTIONS REQUIRED [3PERMIT REQUIRED INSPECTOR'S NAME (PRINT) INSPECTOR'S SIGNATURE DATE: INSPECTOR'S 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 912- S, MA R I N5 Alzcs IUAY _ �. o E II�114, VVM1 VVrT �„�,�pL✓S x�uti vpek,�10 I7-1 Dl.S �a2 IO" _ wau ►� � 15311 . LiV Ito W6 I3u,EXIT Off 0° H�►iW4►! EW -T a " 76'� $ L! TO �7 p ry, �1 GARAGC TPA; F CD 5v .�. ----� N RODtEXTT e. MIR AW' �, �'� TO .WAi-'-- r. b0 7a' 3 a�41 ISO 1�6 ►qr� + E-P9001A lid bb l CASEN��t�fi �r 1 13 1' b o Geos CT WAC 51-51-0325 Section R325 — Adult family homes. SECTION R325 ADULT FAMILY HOMES 8325.1 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. 8325.2 F;Wserved. 8325.3 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 w ith 8325.9 is provided. 3. Type NS2 - Where tw o means of egress are at grade level or ramps constructed in accordance w ith R325.9 are provided. 1x325.4 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 hardware 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 allow ing reentry into the ad ult family home w ithout the use of a key, tool or special knowledge. 8325.5 Smoke and carbon monoxide alarm requirements. All adult family homes shall be equipped with smoke and carbon monoxide alarms installed as required in Sections 8314 and R315.1. Alarms shall be installed in such a manner so that the detection device w arning is audible from all areas of the dwelling upon activation of a single alarm. 8325.6 Escape windows and doors. Every sleeping room shall be provided w ith emergency escape and rescue w indow s 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. 8325.7 Fre apparatus access roads and wate r supply for fire protect ion. Adult family homes shall be served by fire apparatus access roads and water supplies meeting the requirements of the local jurisdiction. 8325.8 Grab bar general requirements. Where f acilities are designated for use by adult family home clients, grab bars forwater closets, bathtubs and shower stalls shall be installed according to this section. 8325.8.1 Grab bar cross section. Grab bars w ith a circular cross section shall have an outside diameter of 1 1/4 inches minimum and 2 inches maximum Grab bars w ith 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. 8325.8.2 Grab bar installation. Grab bars shall have a spacing of 1 1/2 inches between the wall and the bar. Projecting 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 1 112 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 surface finish. 1x325.8.3 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 sw ing-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 between grab bars, regardless of type used, shall be between 25 inches Effective: 2013 July 01 Updated: 2017 February minimum and 30 inches maximum 8325.8.3.1 Fixed position grab bars. Fixed position grab bars shall be a minimum of 36 inches in length and start 12 inches from the rear wall. 8325.8.3.2 Swing -up grab bars. Swing -up grab bars shall be a minimum of 28 inches in length from the rear wall. 8325.8.4 Grab bars at bathtubs. Horizontal and vertical grab bars shall meet the requirements of 8325.8. R325.8.4.1 Vertical grab bars. Vertical grab bars shall be a minimum of 18 inches long and installed at the control end wall and head end wall. Grab bars shall mount within 4 inches of the exterior of the bath tub edge or within 4 inches w ithin the bath tub. The bottom end of the bar shall start between 36 inches and 42 inches above floor grade. EXCEPTION: The required vertical grab barcan be substituted with a floorto ceiling grab bar meeting the requirements of R325.8 at the control end and head end entry pants. R325.8.4.2 Horizontal grab bars. Horizontal grab bars shall be provided at the control end, head end, and the back w all w ithin the bathtub area. Grab bars shall be mounted between 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. 8325.8.5 Grab bars at shower stalls. Where show erstalls are provided to meet the requirements for bathing facilities, grab bars shall meet the requirements of 8325.8. EXCEPTION: Shower stallswith permanent built-in seats are not required to have vertical or horizontal grab bars atthe seat and wall. Avertical floor to ceHing grab bar sha11 be installed within 41riches 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 wall. Vertical bars shall be mounted within 4 inches of the exterior of the shower stall or w Rhin 4 inches inside the shower stall. The bottom end of vertical bars mount between 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 show er 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 w ails. Horizontal grab bars shall not interfere w ith shower control valves. R325.9 Ram ps. All interior and exterior ramps, w hen provided, shall be constructed in accordance w ith Section 8311.8 w ith a maximum slope of 1 vertical to 12 horizontal. The exception to 8311.8.1 is not allowed for adult fanily homes. Handrails shall be installed in accordance w ith 8325.9.1. 8325.9.1 Handrails for ramps. Handrails shall be installed on both sloes of ramps between the slope of 1 vertical to 12 horizontal and 1 vertical and 20 horizontal in accordance w ith 8311.8.3.1 through 8311.8.3.3. 8325.10 Stair treads and risers. Stair treads and risers shall be constructed in accordance w ith 8311.7.5. Handrails shall be installed in accordance w ith 8325.10.1. 8325.10.1 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 w ith R311.7.8.1 through 8311.7.8.4 8325.11 Shower stalls. Where provided to meet the requirements for bathing facilities, the minimum size of show erstalls 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, filed2/1/13, effective 7/1/13. Statutory Authority: Chapter 19.27 RCW. 10-18-036, §51-51-0325, filed 8/25/10, effectve9/25/10. Statutory Authority: RCW 19.27.190, 19.27.020, and chapters 19.27 and 34.05 RCW. 09-04-023, § 51-01-0325, filed 1/27/09, effect ve 7/1 /10. Statutory Authority: RCW 19.27. 74, 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 r41k CITY OF Federal Way PERMIT NUMBER / �t _ / 0 J PERMIT APPLICATION RECEfV APR 3 2017 TARGET DATE (;in( OF FEDERAL WAY MMUNITY' 0?F.V 8ITS ADDRESS SUITE/UNIT # 817- S. NAv4flLt5�W4 9063 PROJECT VALUATION $ ZONING A SESSOR'S TAX/PARCEL # —'9�L -`` ( ✓ — O TYPE OF PERMIT [9 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT ,baa-% Fl)mlk t'S L- ho W10AI '4&IL—1 el'Ly Elf /-/_ a4/e& FDA Mad - "LVn PROJECT DESCRIPTION14 Detailed description of work to yn� -- �S-M �/�D �a o"A u- /�Ce)!! 1&Q/¢/� J- 1Lk1 Uls/bY1Y be included on this permit only S5 NAME ' I M PRIMARY PHONE 7~ PROPERTY OWNER _ MAILING ADDRESS 2 a 3oR E-MAIL STATE ZIPL NAME PHONE MAILING ADDRESS E-MAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # MkM �/ E • �/ /�l /V00 l / PZ 3 RIMARY PHONE — JF33"' LING ADDRESST� 2 .S . 3 S7-. E-MAIL APPLICANT CITY Gc evwL STATE FAX NAME PRIMARY PHONE PROJECT CONTACT (The individual to receive and MAILING ADDRESS E-MAIL respond to all correspondence CITY STATE ZIP FAX concerning this application) PROJECT FINANCING NAME ❑ OWNER -FINANCED When value is $5,000 or more (RCW 19.27.095) MAILING ADDRESS, CITY, STATE, ZIP PHONE I certify under penalty of perjury that I am the property owner or authorised 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 applic n ff e DATE 13A W17 PRIIIT N C� CSC //% j/- 6COC, �l/T / 62— Bulletin #100 — February 22, 2016 Page 1 of 2 k:\Handouts\Permit Application