22-100100City of Federal Way
Community Development Dept.
33325 8th Ave S
Federal Way, WA 98003
Ph: (253) 835-2607 Fax: (253) 835-2609
Project Name: ZURI2 ADULT FAMILY HOME
Project Address: 35436 12TH AVE SW
Building - Single Family
Permit #:22-100100-00-SF
Inspection Request Line: (253) 835-3050
Parcel Number: 257180 0025
Project Description: Verification of Occupancy for Adult Family Home. ***No construction work allowed under
this permit.***
Owner
Applicant
Contractor
Lender
JOSEPH MWANGIZURI2 ADULT
JOSEPH MWANGIZURI2 ADULT
FAMILY HOME
FAMILY HOME
35341 13TH WAY SW
35341 13TH WAY SW
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 Ty e:
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
r
No Fixtures Associated With This Permit !!
PERMIT EXPIRES Wednesday, 6 July, 2022
Permit Issued on Friday, January. 7, 2022
I hereby certify that the above i formation is correct and that the construction on the above described property
and the occupan a 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: U 3 ZZ
Washington State Department Of ReveiRECEIVED
MAR 2 8 2022
Business Lookup CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
License Information:
Entity name: ZURI2 ADULT FAMILY HOME Ll
Business
name:
Entity type: Limited Liability Company
UBI #: 604-795-235
Business ID:
I
Location ID:
Location: None
Excise tax and reseller permit status:
Secretary of State status:
I
Click
Click
Governing People May include governing peop
Governing people T.
MWANGI, JOSEPH
The Bu
nightly
AM
ECEIVED
3 3 (�b
PtA, wc, )'
t1j c-A-( fw
Z I
w'C' qr6��
�AR 7 8 2022
OF FEDERAL
1QPEUNfFY €ELMW
CITY OF PER�ZffI 'APPLICATION
Federal Way JAN 0 7 2022
AA 100100 - SF CITY UNITY DE I Ay
PERMIT NUMBER _ 1 _ '� �` /I ' ` �L
ENT
TARGET DATE '��.rj /'�
SITE ADDRESS SUITE/UNIT #
2. % l�' � f� Or "
PROJECT VALUAT N
ZONING I ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
7a r f
PROJECT DESCRIPTION
Detailed description of work to
pp
�
`
hi e
be included on this permit only
PROPERTY OWNER
NAME % } r
PRIMARY PHONE
MAILING ADDRE9S
CITY S AAIE ZIP
J ' q
NAM
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRES Y
E-MAIL
CI Y
pi
STAVE
ZIP
' U
FAX
NAME1
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY STATE ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
1
r
OWNER -FINANCED
When value is $5, 000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 a of the reliance of the city, including its officers and employees, upon the accuracy of the
informuti[rr± !ppll4d to the r.'� rt of thaw a rli -04
SIGNATURE: _-DATE
r
PRINT NAME: iI .S~ �r �� f ) � 1 r
Bulletin #100 —February 22, 2016 Page 1 of 2 k:\Handouts\Permit Application