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19-105984 c. Building - Single Family City or Federal Way Permit #:19-105984-00-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: COPPER LEAF ADULT FAMILY HOME Project Address: 2919 SW 312TH PL Parcel Number: 150320 0010 Project Description: ALT-Verification of Occupancy for Adult Family Home.***No construction work allowed under this permit.*** Owner Applicant Contractor Lender \ MARY ROSE BIDES MARY ROSE BIDES 2919 SW 312TH PL 2919 SW 312TH PL FEDERAL WAY WA 98023 FEDERAL WAY WA 98023 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 Is this an Online or O.T.C.application" Yes Plumbing to be Included" No y:: S a + ,�. Zy 3 Vie, w''' r 41 PERMIT EXPIRES Wednesday,24 June,2020 Permit Issued on Friday,December 27,2019 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 Washin on d the City of Federal Way. Owner or agent: 60141 �. - //� Date:r )-11v6 6 N I Copper Leaf Home Care 2919 SW 312th PI Federal Way, WA 98023 Covered Patio oP/MINIMPAP....i Ramp m..d.�_._.... . Window Window French Door I Window W/in Closet / ;V "t BEDROOM C BEDROOM D I Itg BATH s LIVING SPACE i DINING AREA '' BEDROOM E „ /' / Closet Closet -...z 1 .11.M...e.I.X1VA* 0 ..11MAN11.6.1.1... MillOPIIMINIONNIMP110 .'''IN —:r—\ Closet BEDROOM B � \ ? N 0 a FE BATHU] BEDROOM A KITCHEN BATH Breakfast Nook cli Fridge . 11 ,office i \ ,... \ Window Window Sink DW Window W/D Furnace WH MAP KEY Elaoricai ea§ Smoke/Carbon Monoxide Detector r,Th Paoli Shut off Sib Fire Extinguisher FE GARAGE valve , EMERGENCY EXIT PATH Water Shut Off Secondary Escape Path v valve Garage door • R32,5.8 Grab Bars in Bathrooms I N/A 0( ,YES NO ' Grab bars shall be installed for all water closets(toilets),bathtubs and showers according to R325.8. FlIlln Water Closets(toilet)shall have grab bars installed on both sides according to R325.8—R325.8.3.1 or R325.83.2. W. 0 Bathtubs shall have two vertical and three horizontal grab bars installed according to R325.8-R325.8.4—R325.8.4.2 0 Shower stalls have two vertical and horizontal grab bars mounted on all sides of shower according to R325.8—R325.8.5— 0 R325.8.5.2. Shower stalls must be minimum size of30 inches deep (by48 inches long(R325.11) El 0 AG103—AG105 Swimming Pool,Spa, Hot Tub f� YES NO AF105.2 Must be surrounded by a barrier that is 48 incl7'ees igh,may have doors and or gates that must have audible alarms when 0 0 opened. AG105.5 EXCEPTION: Pools,Spas or Hot Tubs with a safety cover which complies with ASTM F 1346 PASSED D CORRECTIONS REQUIRED Q PERMIT REQUIRED • e)n/ '1r/ /i G(.. • INSPE/I R'S N E(PRI. AINS' "• ''S // lsR- C!� ,ATE: 33.2 " 'T� U -s fi r,. 1 s3- 3.s--06o 7 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 GENERAL _YES NO Bathroom doors are easily and quickly openable from the outside when locked ___EX Ei Carbon Monoxide alarms a reinstalled as required in R315 on each level of the home. ® 0 Smoke alarms are installed on all levels of the dwelling,i n ea ch resident s leeping room,outside ea ch separate sleeping a rea in the i mmed iate vi cinity of sleeping rooms(R314). Smoke a nd Carbon Monoxide alarms a reinstalled i n such a manner sothat thea udible wa rning may be heard i nail 13 El parts of the dwelling upon activation of a single device. Access road and water supply meet localfirejurisdictional requirements. 01- 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). El 0 Pocket doors shall have graspable hardwareavailablewhen in the closed or open position. t//fr 0 0 R311.8 Ramps YES NO Inside Ramp N/A D 0 0 R311.8.1 Maximum Slope one unit vertical in twelve units horizontal(8.3%slope).(Exception R311.8.1 Not allowed in AFH) 0 0 R311.8.2 Landing Requirements:min.3X3 foot landingattop/bottom,where doors open onto ramps,and where rampchanges directions. 0 0 R325.9.1 Handrails required on both sides of ramp in accordance with R311.8.3.1—R311.8.3.3. 0 0 Outside Ramp N/A 0 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) a. 0 R311.8.2 Landing Requirements:min.3X3 foot landing attop/bottom,where doors open onto ramps,and where rampchanges 0 directions. R325.9.1 Handrails required on both sides of ramp in accordance with R311.8.3.1 —R311.8.3.3. El 0 Guards bel ow a re depicted vertically as an example only.All Ramps must have Guards ET 0 Handrail both sides — — Less than 4" / 34"-38" . Guard —1 36" min 3'x3'mm landing 3'x3 min 1---- -- - landing L. 3' One unit vertical in twelve units horizontal I►--- 3' minimum is an 8.3%slope all along surface of the ramp. minimum R311.2 Means of Egress YES 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. 0 0 R325.4 Operable parts of door handles,pulls,latches,locks and other devices installed in AFH shall be operable with one hand 0 and shall not require tight grasping,pinching or twisting of the wrist(lever-type). R325.4 Required exit door hardware shall unlock inside and outsidemechanismswhenexitingthebuildingallowingre-entry 0 0 without use of key,tool or special knowledge. R311.7 Stairways N/A 0. 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) 0 0 R311.7.5.2 Tread Depth:Min.tread depth shall be in 10 inches(9 inches in structures built prior to July 1,2004) 0 0 R325.10.1 Handrails for Treads and Risers shall be installed on both sides of treads and risers numbering from one riser to multiple 0 0 risers.Handrails shall be installed in accordance with R311.7.8.1—R311.7.8.4 Effective:2013 July 01 Updated:2017 February NAME OF AFH: C)Pitts Now r 4 • - 'I SECTION 5 MUSTBE COMPLETED BYTHE BUILDING DEPARTMENT IN THE JURI SDI CTI ON THE HOME WILL BE 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 CD E AND F AND CLASSIFICATION CODE S, NS1 OR NS2. SECI`ION 5 — BUILDING INSPECTOR'S INSPECTION CHECKLIST 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 NS1—where 1 means of egress at grade level(has no stairs)or ramp constructed compliant with R325.9 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 R325.9 are provided to evacuate residents to public area. SLEEPING ROOM A El Type S OType NS1 0 Type NS2 YES NO Closet door/s are readily openablefrom the inside DYes 0 N Smoke alarm is installed in the bedroom 0 Bedroom door opens easily and quicklyfrom the outside when locked 0 Sleeping room window has a net opening of 5.7SF(minimum dimensions at least 24"high;atl east 20"wide) JJ 0 EXCEPT per R310.2.1:at-grade escape windows–may have net clearance opening 5 SF Sleeping room windowhas a maximum sill height of 44"a bove floor to clear opening;no steps under window a llowec 0- 0 SLEEPING ROOM B 0 Type S Type NS1 0 Type NS2 YES NO Closet door/s are readily openablefrom the inside DYes D No Smoke alarm is installed in the bedroom 0 0 Bedroom door opens easily and quickly from the outside when locked 0 0 Sleeping room window has a net opening of 5.7 SF(minimum dimensions at I east 24"high;it I east 20"wide) J 0 EXCEPT per R310.2.1:at-gradeescapewi ndows–may have net clearance opening 5 SF Sleeping room window has a maximum sill height of 44"abovefloor toclear opening;nosteps under window allowec a 0 SLEEPING ROOM C O Type S El Type NS1 0 Type NS2 YES NO Closet door/s are readily openablefrom the inside ] Yes 0 N Smoke alarmisinstalled inthe bedroom 0 0 Bedroom door opens easily and quickly from the outside when locked 0 0 Sleeping room window has a net opening of 5.7 SF(minimum dimensions atleast 24"high;at least 20"wide) 0 0 EXCEPT per R310.2.1:at-grade escape wi ndows–may have net clearance opening 5 SF Sleeping room window has a maximum sill height of 44"a bovefl oor to clear opening;no steps under window a llowec 0 0 SLEEPING ROOM D 0 Type S 0 Type NS1 0 Type NS2 YES NO Closet door/s are readily openable from the inside D Yes 1:1 No Smoke alarm is installed in the bedroom 0 0 Bedroom door opens easily and quicklyfrom the outside when locked 0 0 Sleeping room windowhas a net opening of 5.7SF(minimum dimensions atleast24"high atleast 20"wide) 0 0 EXCEPT per R310.2.1:at-grade'escape windows–may have net clearance opening 5 SF Sleeping room window has a maximum sill height of 44"a bovefl oor to clear opening;no steps under window a llowec 0 0 SLEEPING ROOM EI D Type S D Type NS1 D Type NS2 YES NO Closet door/s are readily openable from the inside D Yes 0No Smoke alarm is installed in the bedroom 0 0 Bedroom door opens easily and quickly from the outside when locked ‘:t3 0 Sleeping room windowhas a net opening of5.7SF(minimum dimensions at least 24"high;at least 20"wide) 0 0 EXCEPT per R310.2.1:at-grade escape windows–may have net clearance opening 5 SF Sleeping room window has a maximum sill height of 44"a bove fl oor to clear opening;no steps under window a llowec 0 0 SLEEPING ROOM F lO Type S 0 Type NS1 0 Type NS2 YES NO Closet door/s are readily penablefromtheit�siie 0Yes No Smoke alarm is installed in the bedroom 0 0 Bedroom door opense silyand quickly from the bbutsidewhen locked 0 0 Sleeping room wino has anet ope ingof5.7SF(minimumdimensionsatleast24"high:at least 20"wide) 0 0 EXCEPT per R310.2.1:at-grade eS•saewindows—(r have net clear`aneeopening 5SF Sleeping room windowhas a maximum sill height of 44"a bovefl oor to clear opening;no steps under window a llowec 0 0 Effective: 2013 July 01 Updated:2017 February Adult Family Home (AFH) LOCAL BUILDING INSPECTION CHECKLIST RECEIVED Code References: 2015 IRC Section R325 (WAC 51-51) � APPLICATION NUMBER: /9—/05— /9 (1 nFr: 2 7 2019 CITY p$18ga.H1IRtf . AND 4 MUST BE COMPLETED BY APPLICANT BEFORE INSPECTION WILL BE PROCESSED SECTION 1— PROPERTY INFORMATION SITE ADDRESS: ��I / �� I�� ' proRpt� � � �� ASSESSOR'S TAX/PARCEL#M)3°t O_OOT 0 SECTION 2 —APPLICANT INFORMATION PROPERTYOWNERNAME: 10 ", SLIAS/AkAlbj gOS gg.o-r 061.5.DAYTIME PHONE: AFH LICENSEE NAME(IF DIFFERENT):"0rft�'' 1.EW 1101 lvf/ 06 �l DAYTIME PHONE:fs t %'51 - 04)i5 51 - O4I 5 SECTION 3— FLOOR PLAN On a separate sheet of paper (8 1/2 x 11) 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 components for exiting i.e., stairs, ramps, platforms, lifts and elevators. SECTION 4—DISCLAIMER/SIGNATURE BLOCK 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 s ppliedhto the jurisdiction as a part of this application. h Q NAME/TITLE:_ Y`II/I�J(�t,4Vt. (�l/j9•lo�}C, !r`/,1 /0��`JUZf� DATE: �.l-*"1 / l juPROPERTY OWNER APPLICANT Q LICENSEE (Effective July 1, 2013.) Effective:2013 July 01 Updated:2017 February WAC 51-51-0325 -Section R325—Adult family homes. SECTION R325 ADULT FAMILY HOMES R325.1 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. R325.2 Reserved. R325.3 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 R325.9 is provided. 3.Type NS2 -Where two means of egress are at grade level or ramps constructed in accordance with R325.9 are provided. R325.4 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 hardw are 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 allowing reentry into the adult farrily home without the use of a key, tool or special know ledge. R325.5 Smoke and carbon monoxide alarm requirements.All adult family homes shall be equipped with smoke and carbon monoxide alarms installed as required in Sections R314 and R315.1. Alarms shall be installed in such a manner so that the detection device warning is audible from all areas of the dwelling upon activation of a single alarm. R325.6 Escape windows and doors.Every sleeping room shall be provided with emergency escape and rescue windows as required by Section R310. No alternatives to the sill height such as steps, raised platforms or c`ler devices placed by the openings w ill be approved as meeting this requirement. R325.7 Fire apparatus access roads and water 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. R325.8 Grab bar general requirements.Where facilities are designated for use by adult family home clients, grab bars for water closets, bathtubs and show er stalls shall be installed according to this section. R325.8.1 Grab bar cross section.Grab bars with a circular cross section shall have an outside diameter of 1 1/4 inches minimum and 2 inches maximum. Grab bars with 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. R325.8.2 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 shower 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 1/2 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,when mounted, shall not rotate, spin or move and have a graspable surface finish. R325.8.3 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 swing-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 betw een grab bars, regardless of type used, shall be betw een 25 inches Effective:2013 July 01 Updated: 2017 February minimum and 30 inches maximum. R325.8.3.1 Fixed position grab bars.Fixed position grab bars shall be a minimum of 36 inches in length and start 12 inches'from ' the rear w all. R325.8.3.2 Swing-up grab bars.Sw ing-up grab bars shall be a minimum of 28 inches in length from the rear w all. R325.8.4 Grab bars at bathtubs.Horizontal and vertical grab bars shall meet the requirements of R325.8. R325.8.4.1 Vertical grab bars.Vertical grab bars shall be a rrinimum of 18 inches long and installed at the control end w all and head end w all. Grab bars shall mount within 4 inches of the exterior of the bath tub edge or within 4 inches within 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 bar can be substituted with a floor to ceiling grab bar meeting the requirements of R325.8 at the control end and head end entry points. 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. R325.8.5 Grab bars at shower stalls.Where shower stalls are provided to meet the requirements for bathing facilities, grab bars shall meet the requirements of R325.8. EXCEPTION: Shower stalls with permanent built-in seats are not required to have vertical or horizontal grab bars at the seat end wall. Avertical floor to ceiling grab bar shall be installed within 4 inches 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 w all.Vertical bars shall be mounted within 4 inches of the exterior of the shower stall or within 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 between 33 inches and 36 inches above the floor grade. Horizontal grab bars shall be a maximum of 6 inches from adjacent walls.Horizontal grab bars shall not interfere with show er control valves. R325.9 Ramps.All interior and exterior ramps, w hen provided, shall be constructed in accordance with Section R311.8 with a maximum slope of 1 vertical to 12 horizontal. The exception to R311.8,1 is not allow ed for adult family homes. Handrails shall be installed in accordance with R325.9.1. R325.9.1 Handrails for ramps.Handrails shall be installed on both sides of ramps between the slope of 1 vertical to 12 horizontal and 1 vertical and 20 horizontal in accordance with R311.8.3.1 through R311.8.3.3. R325.10 Stair treads and risers.Stair treads and risers shall be constructed in accordance with R311.7.5. Handrails shall be installed in accordance with R325 10.1. R325.10.1 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 R311.7.8.4 R325.11 Shower stalls.Where provided to meet the requirements for bathing facilities, the minimum size of shower stalls 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,filed 2/1/13,effective 7/1/13.Statutory Authority:Chapter 19.27 RCW. 10-18-036,§51-51-0325,filed 8/25/10,effective 9/25/10.Statutory Autho ty:RCW 19.27.190,19.27.020,and chapters 19.27 and 34.05 RCW.09-04-023,§51-51-0325,filed 1/27/09,effective 7/1/10.Statutory Authority:RCW 19.27.074, 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 N ' RST APPLICATION CITY OF , Federal Way PERMIT CENTER+33325 8'"Avenue South + Federal Way,WA 98003-6325 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com DEC 2 7 2019 CITY OF FEDERAL W Y PERMIT NUMBER _ S c, DELL s / TARGET DATE SITE ADDRESS / // SUITE/UNIT# 29(°� S� 312A PL F-D til, v1/A/ VIA V0d3 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL N $ ( S 03 000 ! o0 TYPE OF PERMIT 0 BUILDING 0 PLUMBING MECHANICAL0 DEMOLITION ❑,EfNGINEERING ❑ FIRE PREVENTION NAME OF PROJECT ADULT ��IV1u_ 140M-t (t n Il R'') 131,11L-DU4C /t1S prc,TiO J , L AUL r(4, y HCI N 'IJ}F) &UIOC G INS'ettTION 12-EMUI IZ£J) .Y PROJECT DESCRIPTION fworkt -1S TOL.t( J /P G p'1►S �� AD FAA/14,y 1 `► �jIJS(/JS5 Detailed description of work to be included on this permit only NAMEka A . 6 S / cy L', g+J'�,1 s PRIMARYPHO_dlNE 3;1-061s" N PROPERTY OWNER MA D�f Ss j vv 124h pt., i gas E-MAIL-M 'I7 torK1110fAfNROM}I,,C.0IN. CITY.pr{�}t� ;A'+� ST T ZIP tl(/f�l 3 NAME .IYLIF." 1l'{V�'/j` 1��`/�/�jy PHONE MAILING ADDRESS EMAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS UCENSE N /� y��yA' ,,//II / 'r^/y�y.,\/" NAV 1 O A �(I at c /„�I,��/ 1 a I♦ g'J` l PRIMARY PHO yy3�iU',^f I�A (� MAIU11N1vGS1ADDR \V 1Jth rL, 'Y 1��` �E-MAILegen 1 NrAV l ♦QC_J mi... g ir- APPLICANT 3,91Q (12— 1 § I A....A CITY 1...[�Y7 17 A L V�/� \.AITp ZIPS'//', i 3 FAX1 _3 3'44- I-4J-4 NAM Itatt16 A. V(O l J W'\ UVV• PRIMCA7R)0GE JCI - 06`s PROJECT CONTACT !✓ply, ,Iy. .EMAIL / � �, t� A f[� .f�1 .+ ow, M IGI RESS� i �� `� �i CO re a-li Af T,TI�V'6IY .li.o 7'_ The individual to receive and respond to all correspondence concerning this application) " w, V ST ' V1,71 y ](0o,3 FAX 'TV- 1.3)-4 ' PROJECT FINANCING NAME Nutt I" 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 lam 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. s� SIGNATURE: WW1\filU S 1"/"f.---7 DATE I'f u(9 1 PRINT NAME: Y1�1 LD1' tg...e* L. tS(F5 Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application