09-102895City of Federal Way
Community Development Services
P.O Box 9718
Federal Way, WA 98063-9718
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: GRAF (CAMELOT SPACE 60)
Project Address: 3001 S 288TH ST Space 60
Project Description: NEW -Installation of manufactured home.
'iuild'ing - Single Family
Permit #: 09 -102895 -00 -S -F
Inspection Request Line: (253) 835-3050
Parcel Number: 042104 9155
Owner
Applicant
Contractor
Lender
GENE GRAF
HORSLEY'S MOBILE HOME
HORSLEY'S MOBILE HOME
8118 PACIFIC HWY E
SERVICE
SERVICE
TACOMA WA 98422
PO BOX 764
HORSLMHO74DC (3/22/10)
PUYALLUP WA 98371
PO BOX 764
PUYALLUP WA 98371
Census Category: 113 - New Manufactured/Factory-Built Home, ON LOT
Includes: #1 #2 #3 44
Occupancy Class:
Construction Type:
Occupancy Load:
-Floor Area (sq. ft.) 1 0 0 0 0
Additional Permit Information
New / Add ILintnil Sq meet - lst Floor .................. -0 Nc« /Additional Sq. I eel - 2nd Floor ................... 0
New/ Additional Sq. meet - 3rd Floor....................0 Now/ Additional Sq. feet - Bascirient.,................. 0
New / Additional Sq. Feet - Deck......:;...:.......:...... 0 New / Additional Sq. Feet - Garage.............:.........0
New / Additional Sq. Feet - Other........:..........:...A New / Additional Sq. Feet - Total.......................... 0
No Fixtures Associated With This Permit 1!
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 Tuesday, January 26, 2010
Permit Issued on Thursday, July 30, 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: p Date:
FiHP"J�P IZ/!P/09
THIS CARD IS TO REMAIN ON-SITE
CITY OF
Federal Way Co uctionE n� ection Record
NSPE
QUATS: (253) 835-3050
PERMIT #: 09 -102895 -00 -SF Address: 3001 S 288TH ST Space 60
Owner: CAMELOT SQUARE INC FEDERAL WAY; WA 98003
Scheduled inspections uta► be l'aiied if this card is not on-site. D iw T L45i THI5 ,AR.1Q. Inspections are [luted as close to seyucntial order as
Possible (read left to right, top it) hottom]. Please schedule inspections as appropriate. Work must not be covered until it is approved. Check ►lith your
inspector iryou are unsure about any oftize inspechons or the inspection sequence. Ongoing inspections are logged on the back of this _-m
❑
SWM Precon Site Mtn (4404)
Approved
❑
Int:tiai Erosion Control (4365)❑
To be done prior to breaking ground
Interim Erosion C
Approved
BY
Date
BY
Date
BY
Date
❑ Blackin Approved
Downs (4015) EOFimal Erosion Control01375) 9k rtinApproved Approved ❑ 5' `� foal [��$Q)
Approved
BY Date$ Date By Date
For inks hector reference on
Rough Electrical [By
_
Approved IAL - Electrical
Approved
LBy Date
Date
RECEIVrimfw AED
Federal WayUL 3 0 Zp nq PERMIT
6, SF SF CO ME EL PL DE EN FP
3.7375 gni R V4 6 S1D!?t'i! � PO SD7C 97
5-34JIIL WAY, FAX
M -W -5477g- �DER J DLI CATI O N
753.835 $6a 7• F 1X T') 835?G It • � A 1, A p
tLivio'cip
The following is f
�4u>ir+ed Wormation — an incomplete awfication will not be accepted Pleaset
P� Ugibuj On ink) or type,
SITE ADDRESS d —19c� �� % (� r O O
ASSESSOR'S T (� � /UNIT #
AX/PARCEL 9 --�! � _ � SUITE
LEGAL DESCRIPTIONLOT SEM (so
(eg. Acme Estates, Lot 1J
TYPE OF PERMIT ❑ BUMDIIFO ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ EITGMEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work mduded ons t'tOle r
n
G !L
-1
PROJECT NAME (Name of &g&IM or puffw
�. 1.
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
'�fAIWHQ ADORES$
MMPANY NAME
I eS zed !?it okrL 5.s
iA1LING ADDRESS
o'7 Y' V G
z-1_ 'Z0- 1866
ZIP CELL PHONE
UPIRATION DATE
FAX NUMBER
(� -A Sz6-06 pry
ZIP
S
`z 2-�- 14` 6C
❑ Architect ❑ Tenant ❑ FAx NLfh{BER
Agent ❑Other { � -
iVAME
PRIMARY PFIgiVE lrMAILADDPESS
+vnMa
Per.RCw.19.27, ogs:
LhM4A1LjNG;RESSf:�I� Lender infarncatlore is required tf project vatw ezceecit$,ppp
CITY, STATE, ZIP PHONE
l � -
EXISTING USE f J , (_ 14445,4,,7 rte '
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE
VALUE OF PROPOSED WORK 21
SERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED
WATER SERVICE PROVIDER �REQIIiRED? ❑ YE3 13 NO
SEWER SERVICE PRO' iAEi�q � EHAVEN C3HIGE INE ❑ TACOMA C3PRIVATE (WELL)
MAVEN ci FiIGT� INE 13 PRIVATE 1SEPTYm
Indicate number of each type of facture to be installed or relocated as part of this project Do not include existing factures to remairL
MECfMec r•
MCA
A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITHAPPLICATIONJ
Valuee oof MeritarLical Work $
BATHTUBS (oz7Lb/shmnrc=W*
LAVE (Baasia3*
RAINWATER SYST
VACUUM BREAKERS
EVAPORATIVE COOLERS
GAS PLI'E ❑UTLI n WOODSTOVES
AIR HANDLING UNITS
DRINKING FOUNTAINS
GAB WATER HEATERS MISC (Deacnbe)
BBQS
FANS
FIREPIACE INSERTS
HOODS (cammecaq
BOILERS
FURNACES
RANGES
COMPRESSORS
GAS LOG SETS
REFRIG. SYSTEMS
DUCTS
IPLUAit MG
URINALS MISC (Describe)
BATHTUBS (oz7Lb/shmnrc=W*
LAVE (Baasia3*
RAINWATER SYST
VACUUM BREAKERS
DISHWASHERS
SHOWERS
WATER CLOSETS (romp
DRINKING FOUNTAINS
WASHING MACHINES
ZLZCTRIc WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
o that I arrt the property owner or authorized agent of the property awnsr. I Certgy that to the heat of my
I errt(fy under penalty fP+du+?I Ifsatian if true Brad Correct Y cert(/4y that I will comply With all applicable
P"
It the Warmation submitted in support of this pmt s app
City of Pederal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the issuance of this permit
does not remove tits owner's responsibiii[y far compliance with local, stats, or federal tacos ragutat&W construction or env[r orrmantat laws
I further agree !o bald harmless the City of Federal Way as to anyclaim (including coats, expenses, and attorneys' fees incurred in the
urry person+, including the undersigned, and filed against the city, but army
investigation and dafartse of such claw, which -a_V be made by c
where such claim arises out of the reliance of the city. including its officers and amptagees, upon the accuracy of the information supptted to
the city as apart of this appUcatton.
SIGNATURE:
Owner
o NEW o ADDITION a ALTERATION
BUILDING SHELL ONLY? o YES a NO
2,ONIIIG DESIGNATION
s-tEW ADDRESS REQUHZED? a YES a NO
PLATTED LOT? a YES o NO
Authorized
o REPAIR a TENANT IMPROVEMENT
BASIC PLAN? o YES
CHANGE OF USE? a YES
UP/SBPA/SU?
DEMO PERMIT
:ri
:,.
o. NO
o NO
a NO
o NO
Bulletin #100 — January 1, 2009 Page 2 of 4 WandoutsWermit Application
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