19-101797 Building - Single Family
City of Federal Way Permit #:19-101797-00-SF
Community Development Dept
33325 8th Ave S
Federal Way,WA 98003 Inspection Request Line: (253)835-3050
Ph:(253)835-2607 Fax:(253)835-2609
Project Name: IAROSHCHUK
Project Address: 30825 10TH AVE SW Parcel Number:024800 0100
Project Description: ALT-Fire damage inspection only. NO construction work approved with this permit.
Owner Applicant Contractor Lender
MYKHAILO IAROSHCHUK MYKHAILO IAROSHCHUK
30825 10TH AVE SW 30825 10TH AVE SW
FEDERAL WAY WA 98023 FEDERAL WAY WA 98023
Census Category: 434-Residential alt/add-no change in number of units
Includes: I #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.)
Additional Permit Information
Mechanical to be Included9 No Is this an Online or O.T.C.application9 Yes
Plumbing to be Included? No
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PERMIT EXPIRES Sunday, 13 October,2019
Permit Issued on Tuesday,April 16,2019
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. Date: D�• 16 • I
RECEIVED
„„....._ .44044.S..,. APR 16 2019 PERMIT APPLICATION
CITY OF
Federal Way CITY OF FEDERAL-WAY PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
iOMMUNITY DEVELOPMENT 253-835-2607 + FAX 253-835-2609 +permitcentelnacityoffederalway.com
PERMIT NUMBER I q _ I 0 I �? ` 7 _ S F
_ — — TARGET DATE
SITE ADDRESS SUITE/UNIT#
0825 10-/t, 19Ve SUf Fecevs,1 VVa WA fleo2, 3
PROJECT VALUATION ZONING ASSESSOR'SC_ C � � O O t O
T.�i7�C ARM _ \
$ v\
TYPE OF PERMIT ,'BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT 1 A f OS be In L&i
PROJECT DESCRIPTION F...re— eNe_c i cvcL7 -F t T r si rt 1d i>,4s •
Detailed description of work to `�
be included on this permit only
NAME PRIMARY PHONE
Mtik�e.:10 Tv.r.oshc. l4�k 253-335-8802.
PROPERTY OWNER MAILING ADDRESS
3 08 25- /o-{it A VC S 1`'1\Xo..x e Vi 0$041.11 .
CITYe c Q co ) tASTATE ZIP ,O e D 2 1 a COML
. .. .._ NAME Ko�---�a ii4 Kolic1r0'4u-k PHONE ^ ni7g g I '\'V
MAILING ADDRESS E-MAIL L 'J` G!i Q
CONTRACTOR
CITY ` SL'ATA 1 8 0 O I ZIP FAX
Pi f
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ / .
NAME PRIMARY PHONE
o.len.c_
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
• -- ._ NAME _ ----- — -- PRIMARY PHONE __.
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence -
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 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 a part of this application.
SIGNAT . —I elf
O tt. l b • I
PRINT NAME: "l �I•f n 0 ,lo �i
--o lr os 1,e N....-
`
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application