18-105563City of Federal Wry
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 635-2607 Fax (253) 8352609
Project Name: STASYUK
Project Address: 34626 10TH PL SW
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Building - Single Family
Permit #:18 -105563 -00 -SF
Inspection Request Line: (253) 835-3050
Parcel Number: 132173 0530
Project Description: REP- Inspection of fire damage. ***NO construction work approved under this permit***
Owner
Applicant
Contractor
Lender
YAKOV STASYUK
YAKOV STASYUK
OWNER IS CONTRACTOR
34626 10TH PL SW
34626 10TH PL SW
FEDERAL WAY WA 98023-8426
FEDERAL WAY WA 98023-8426
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.)
Additional Permit Information
Mechanical to be Included? ..................................... No Number of Stories................................................... 0
Is this an Online or O.T.C. application? .................. No Plumbing to be Included? ........................................ No
PERMIT EXPIRES Saturday, 25 May, 2019
Permit Issued on Monday, November 26, 2018
1 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
Q� Washington and the1City of Federal Way. (�
Owner or agent: T�C/y %5'P� ?"i O,C� N CLOAK, Date: I' — 2 G —I
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DECEIVED
CITY OF ^� NOV 2 6 2018
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER (� _ l 0 5 5 ` (✓^ 3 _ TARGET DATE f
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SITE ADDRESS Z V Z-%
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SUITE/UNIT #
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PROJECT VALUATION
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AS ESSOWS TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
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NAME iq)4-10 V i
PRINURY PHONE
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PROPERTY OWNER
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STATE
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ZIP „���
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NAME
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PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
.EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME e
Dwnr
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT-
CITY
STATE
ZIP
FAX
NAME -
PRIMARY PHONE
PROJECT CONTACT
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MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 apart of this application.
LA*1
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\HandoutsTeimit Application
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