09-104653 4.2
�Buildin - Single Family'
City
CommntyDveopmentServices rJ Permit #: 09-104653-00-SF
P.O.Box 9718 44
Federal Way,WA 98063-9718 i
Ph (253)835-2607 Fax (253)835-2609 { '` Inspection Request Line: (253) 835-3050
: : 4 .vim hlrea
Project Name: GUROVA
Project Address: 3001 S 288TH ST Space 81 Parcel Number: 042104 9222
Project Description: NEW-Installation of mobile home in Camelot Square Space 81
Owner Applicant Contractor Lender
CAMELOT SQUARE INC ZINAIDA GUROVA COASTAL TRANSPORTATION
3001 S 288TH ST 10230 SE 213TH PL COASTT*140MB(5/18/11)
FEDERAL WAY WA 98003-8019 KENT WA 98031 19010 APRICOT SW
ROCHESTER WA
Census Category: 112 - New Manufactured/Factory-Built Home, IN PARK
Includes: #1 #2 #3 #4
Occupancy Class:
Construction Type:
Occupancy Load:
Floor Area(sq.ft.) 0 0 0 0
Addition Orral dnfoJ mate• ',''4--4V,44:6.
New/Additional Sq.Feet- I st Floor 1782 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 Included9 No
New/Additional Sq. Feet-Total 1782
No Fixtures Associated With This Permit !!
r., �. 0 Wil,`` dt.
CONDITIONS:
Installation shall be in strict accordance with the manufacturer's installation instructions or professionally
engineered installation design,which shall remain on-site as required by Washington State law.
PERMIT EXPIRES Monday, May 24, 2010
Permit Issued on Wednesday, November 25, 2009
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: // ç- 0?
- ` THIS CARD IS TO REMAIN ON-SITE
CITY OF
Construction Inspection Record •
Federal Way INSPECTION REQUESTS: (253) 835-3050
PERMIT #: 09-104653-00-SF Address: 3001 S 288TH ST Space 81
Owner: CAMELOT SQUARE INC FEDERAL WAY, WA
Scheduled inspections may be failed if this card is not on-site. DO NOT LOSE THIS CARD. Inspections are listed as close to sequential order as
possible(read left to right,top to bottom). Please schedule inspections as appropriate. Work must not be covered until it is approved. Check with your
inspector if you are unsure about any of the inspections or the inspection sequence. On-going inspections are logged on the back of this card.
0 SWM Precon Site Mtg(4400) ❑ Initial Erosion Control(4365) ❑ Interim Erosion Control (4370)
Approved To be done prior to breaking ground Approved
By Date By Date By Date
El Blocking/Tie Downs(4015) ❑ Final Erosion Control(4375) Skirting/Final(4250)
Approved Approved Approved
By /71 Date j I / /J By Date By j Dateg...77,6
•
0 Rough Electrical ❑ Final Electrical Right of Way
Approved Approved Approved
By Date By Date By Date
crnr ar WCEIN/L
�PERMIT
S M�' CO ME EL PL DE EN FP
Federal '
SERV[C. F
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D's nASS�SOR'S T,�[pARI:BT, SITITE[�T 0 ZONING _
NAME OF PRO FS=' 1 V �� '� �% ✓ `� C 'rfG , OF
(Tenant or Harneoumer Name) lJ
BUILDWG ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑FIRE PREVENTION
PRDJEC'C DESCRIPTION
Detailed description of work to
be included on this permit only
}� PEQME PRIMARY PHONE
~ .. NAME
PROPERTY OWNER /~0 CA / 0/Gl l +-t rD �� E-MAIL
MAILINGADDRESS, C/ITY. STATE, ZIP
oJvi --� o S 1i Z/ -� PROJECT CONTACT
❑
OWNER IS ALSO: 0 CONTRACTOR ❑ APPLICANT PRIMARY PH`ON[E�
AM U7,
(�60 FAX / (:�
MAILING ADDRESS, CITY, STATE, ZIP �9 � (• �V'e-/' , , - 9 6 O /
%C9HTRACTOR 1(� [,, r , col S r d� 7
VV �I / v ��� 1 {,� //��►. g1{g1g,AT/SON DATE FEDERAL WAY BIISII1E39 LICENSE N
WA STAT6CONTRACf LICEN 6 1 l V F 7 ' j f ��
LLB- �.S PRIMARY PHONE _
xAME ^� � ✓� vim` ��� o�if5 _ � tS DS
Z- Gt e l N q FAX
APPLICANT MAILING ADDRESS, CITY, STATE, ZIP � `C wr/ _
1 2j 9 t-- 'Al PRIMARY PHONE
PROJECT CONTACT NAME
FAX
(The individual to receive arld MAILING ADDRESS, CITY, STATE, ZIP
respond to all corresponderlm
concerning this application) P-MAM
PRIMARY PHONE
ALTERNATE CONTACT NAM!
PROJECT FINANCING
NAME ❑ OWNER -FINANCED
PRIMARY PHONE
Reguiredforprojects with
value of $5, 000 or more MAILING ADDRESS, CITY, STATE, ZIP r
(RC:iV I9.27.095) 1
owner or authorized agent of the property aeuner. I Certify that to the
a er' that I am the proPertg that I wal comply
I certifr,I render penalty f p fury ort o this permit appit0rizen is trees and Correct. I certify
hest of my knowledge, ifee information submitted inPp f Ilareea will► Local, state, or federal taus regulating
with all apptictthle City of Federal Way regulations ,pertaining to the ty for au compliance by the issuance teof a permit. I understand that
the issuance of this permit does not remove the ovmer's responsi6clety cittim [tncIuding costs, expenses, and attorneys' fees irtcurred
construction or environmental laws, the undersigned, and filed against the
I further agree to Ito Id harmless the City of Federal y b m to by person, including
euhich may he movie by any � ffi to employees, u on the accuracy of the
in the investtgation and defense of such claim), y
city, but only where such claim sex o f this ecppiir lion the �tJ, inaludin its officers and emp y
information supplied to the City D
DATE r7�--
SIGNATURE:
PRINT NAME:. -- k:\Handouts\Permit Application
Page 1 of 4
Bulletin #100 - 4/17/2009
�r:1ue o 1�fe�hanic�al Work $ MECHANICAL FIXTOi-c.S
IndlCute number of each ty e s
�R II+°�NDLING UNITS 9 - urie to be installed orrelocute asfA OPxOFBID DREsT�TE
FANS ri s this rs g 11dl7ST BE PROMED
AIR CONDITIONER J ct. Do not include
BOILERS FIREPLACE INSERTS GAS PIPE OUTLETS existing ores to remain
COMPRESSORS FURNACES HOODS rco OTHER {Descrlba)
DUCTING LOG SETS I
GAS I'IOY' WATER TAN",,,,
GAS PIPING REFRIGERATION SYST
77T7���,,���,, IX
WOODSTOVES
Indicate numbers each PL IMBING rl
BATtITUBS °f re to be installed orre[o Tv EIS
rrated as part ❑ t DISHWASHERS LAVS IH.ds;� f hisp''siect. Do not ind
DRAINS RAINWATER SYSTEMS I — TOILETS udE esh fires to renzain,
�
DRINKING FOUNTAINS — SHOWERS URINALS WATER PIPING
HOSE BIBBS SINKS (Kttchen,Uol ty) — VACUUM BREAKERS OTHER (Describe)
SUMPS — WATER HEATERS(,,
MASHING MACHINES
on
pRo 7 oALnATrCE TOTAL F�l?
WATER PURVEYOR ORAL INFpRNIATIQN
,� SEWER pVEYOR
EXIB'1'IH0/p VALUE OF E70STI r, IlfrpROVg
R$VI6U8 USE NEr�7'rS
LOT SIZE (Ia Square Feet)
STMG FIRE Sp yISLER SYS r F,E7p PROPO
FIRE S 0 Yes t7 No sso U+ RESSION SYSTEM?
❑ Yes ❑ No
AREA DESORPI•ION in s f quare feet)
BASEMENT
FIRST FLOOR (or1l+Iobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (dam)
Area Totals
ktESIDEN`J' 6&
EKTSTIIIi(I pROpOSEI]
To'1`AI.
**nzw OAM
7�
# Or BEDROOMS
ARFA DESCrraN in CRCIAL — IADDZTIQP
Area
NEWBMDMG Soars Feet Occupaacy Groups) Construction
ADDiTZQN e
FOR OFFICE USE
# of
Stories Additional Information
AREA DES GR-rn'rloNflNIIVIERCIAL — Area REMQDE,I.IZ'EnrA.NT ins um Feet Occu Y IMP VE�N�,S
TOTAL � Panc Group(s) Canstructioa # of
e Stories AdditionalInforTES AREA ONLY mation
PROJZCT.AREA ONLY
Bulletin # 100 — 4/17/2009
Page 2 of 4
k:\HandoutsTermit Application