09-101722E(253)I335-2'6007
Federal way
velopment Services
Box 9718
WA 98063-9718
Fax: (253) 835-2609
r►u3eci iName: CAMELOT SQUARE
Project Address:
Project Description:
3001 S 288TH ST SP 146
y NEW - Installation of 720 sqft mobile ho-
0—wnilL
CAMELOT SQUARE INC
3001 S 288'fli ST
FEDERAL WAY WA 98003-8019
li -
ROGEt.10 PENA
31001 S 288TH ST SP 146
FEDERAL WAY WA 98003
'wilding - Singe Faxhly
Permit #: 09 -101722 -00 -SF
Inspection Request Line: (253) 835-3050
Contractor
ESE CONS"1'R UCTION INC
ESEC01*000RA (12/1/09)
7189 F & S
SEDRO WOOLEY WA 98284
Parcel Number: 042104 9155
ender
Census Category: 11z - New Manufactured/Factory-Built Home, IN PARK
Includes: #1
#2 #3 #4
OccupanI'llcy Class:
Construction T e:
Orctl ancv Load:
Floor Area (sq. R.) n
Additional Permit Information
New /Additional Sq, l e e t - I st Floor .................... 720 AN _
New/ additional Sq. Feet - 3rd Floor—
loor....................0 Ness Additional Sq. Feet - 2nd Floor............. 0
New/ Additional Sq. Feet - Deck .......................... 0 New 1 Additional Sq, FCet - Basenlent...,,,,.,,,_
New/ Additional Sq. Feet - Other..........................New/ Additional 5 . Feet -
0 q Garage.......... ..0
New/ Additional 5q. Feet - Total .................... 72'0
No Fixtures Associated With This Permit!J
CONDITIONS:
Subject to field inspection without plans.
PERMIT EXPIRES Wednesday, November 4, 2009
Permit Issued on Friday, May 8, 2009
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
and the City of Federal Way, Washington
Owner or agent: f �' �F;,
Date: c)
Ft IIAUAa a It /#p
ITHIS CARD IS TO VF,MAIN ON-SITE
CITY OF �ommun
:it
Development Inspection on ReC®rcFedera I Way IVR INSPECTION REQUEST PHONE (253)
835-3050
PERMIT #: 09 -101722 -00 -SF
Owner: CAMELOT SQUARE INC
Address: 3001 S 288TH ST SP 146
FEDERAL WAY, WA 98003
This card is part of your required inspection documents. Scheduled inspections may be failed if this card is not on-site. DO NOT LOSTf H1afARU
Inspections are listed as close to sequential order as possible (read left to right, top to bottom). Please schedule inspections as appropriate. Work inust 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.
❑ 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
❑ Blocking/Tie Downs (4015)
Approved
By C &J Date _ d
❑ Final Erosion Control (4375)
Approved
By Date
For inspector reference only
❑ Skirting/Final (4250)
Approved
By Date
ID Rough Electrical ❑ FINAL - Electrical
Approved
Approved
By Date
BY Date
cruor IVF J
Federal WayLL�
hhM�A PERMIT F F CO ME EL PL DE EN FP
:L� 42X
roarwrvrrT nsvewr�IrT sv[t�$i Y 0 � �r�,�
333258'+�RV6MJ85Df1J'H•P097.18 APPLICATION
FEDBRRL wRY .ISA 4lQG3,9718 / /
i
25".M -2W -AM 253 -"&,?6" �� ��
�uiury, riirmffr4sfem1l�_mr.cam R R /�
The following ds requi1c"vorntattort —an incomplete application will not be accepted. Please print legtbly (in ink) or type.
SITE ADDRESS
ASSESSOR'S TAX/PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
PROJECT I-NFOR LATION
SUITE/UNIT #
LOT SIZE (sfl
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEE UNG ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of workvu:baded on this permit ortful
PROJECT NAME (Name of Rgak s or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
E PEOPLE INFORALATION
NAME PRIMARY PHONE
MAI Ir1G ADDRESS CrIY, STATE, ZIP E-MMLADDRM
COMPANY NAME �Y
r • -` i c '`� � - t•� . I -' r_'
APPLICANT NAM fj
'•f%-�:-�� J�D1�tC�
OFPFI�CyE.PHON'7E♦ C�
(•-rc-rr.) /4: o - �/ Yt
MAILING ADDRESS
11;5 00'1'4124-1.
CITY SIAM ZIP
�( �GZ � y'
W��I� 1
CELL PHON&0
(��` °
'7 �3-5-9%
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CONTRACT40WS REOIBTRATION NUMBER
BXPIRA ItlN ATE
E-mAll, ADDRESS
COMIjANY NAM
�e(DPcti
�MAILJKO
APPLICANT NAME
OFE•ICE PHONE
(
_
ADDRESS �
CIIY, STATE, ZIP�q
ujQ
CELL PHONE
J'C lbFr
- 11 if -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent XOther
FAX NUMBER
( )
-
NAME PRIMARY PHONE E MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender i4onnation is required iJprofea value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE $
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINSLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLII7E ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE 0 PRIVATE iSEPTICI
Indicate number of each type offtxture to be installed or relocated as part of itis project. Do not bwklde
existutg fixluries to remain.
1 c.aA11RCAL
Value of Medwru'cal Work
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED Wr MAPPLICATI01V)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERSMISC {I]cscribe)
BOILERS
FIREPLACE INSERTS
HOODS [c«
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REMO. SYSTEMS
BATHTUBS (-TUb/M-WwCombol
IIP/SEPA/SU?
URINALS MKSC (Deaariba)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS Rdrq
PAJ=MC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I cerHjj under penalty of perjury that I am tha prapw*j owner or authorized agent of the prnparty owner. r certVy that to the best of my
knowfedga the infarmation submitted to support of this permit application is trete and correct. I certify that l will comply with alt applicable
City of Federal Wong regulations pertaining to the work authorized by the ixsuance of a permit. I understand that the issuance of this permit
does not remove the ownWa reaponsibitityfor compliance with focal, state or federal laws regutating construction or envtronmental Kava
I further agree to hold harrnlQss the City of Fedaraf Way as to any claim lincfuding costs, expenses, and attorneys' fees incurred dee the
investigation and defense of such elatmJ, which may be made by any parson, 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 empfeyeas, upon the accuracy of the inforenatiort supplied to
the city av a part of this appricat(on. --J
SIGNATURE:2 1 r, lC'e) PC- HC2(
Property Owner and/or Authorized Agent
a NEW a ADDITION
o ALTERATION
o REPAM a TENANT MWROVEMENT
BUILDING 8MU ONLY?
a YES a NO
BASIC PLAN?
a YES
a NO
ZONING DESIGNATION
CBANGE OF USE?
a YES
a NO
NSW ADDRESS REQUIRED?
a YES a NO
IIP/SEPA/SU?
o YES
a NO
PLATTED LOT?
a YES a NO
DEMO PE U.MlrT RDQIIn;MD?
a YES
a NO
Bulletin #100 - January 1, 2009 Page 2 of 4 Mandouts\Permit Application