18-102604RECEIVED PERMIT APPLICATION
CITY OF J U N 1 4 2018
PERMIT CENTER + 33325 81h Avenue South +Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + erntitcenterl'' 'tvoffederalwa .com
CrrY OF FEDERAL WAY
f /COMMUNfTY DEVELOPMENT
PERMIT NUMBER v _ 1 � / ! —Y C I f� J 7
��ii r V TARGET DATE _ J
SITE ADDRESS SUITE/UNIT #
-�g� r, f -I'v- x�
PROJECT VALUATION ZONI# ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
M H,4 i L..1[ i, t-lb
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PROJECT DESCRIPTION
�
Detailed description of work to
be included on this permit only
PRIMARY PHONE
f
PROPERTY OWNER
r, ADDRESS
E-MAIL
CITY
ZIP
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/)IZ
GA
NAME IC7 C��1 �� �(J I' ✓L/LC��'"�'`vv !
P y U/ /
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E-MAIL
CONTRACTOR
ZIP � � j q �
FAX
W ST TE CONTRACTOR '@ LICENS aI, I
EXPIRATIP� DATE
FEDERAL WAY BUSINESS LICENSE #
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PRIMARY PHONE
APPLICANT
MAFM.IAD�I�RESS _�
fj� LIf� '/JJI-C
E-MAIL
CI
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STA 8
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ZIP I I " /
e
FAX
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PRIMARY PNIONE
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PROJECT CONTACT
The individual to receive and
°LAW�} IN}G} ADDEMS
L' � fries L>r�L
'L 1.
respond to all correspondence
concerning this application)
CI STAT
ZIP
FAX
PROJECT FINANCING
NAME
❑ 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 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, expense -a, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed agairast the city,
but only where such claim arisas 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.
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SIGNATURE: °"'4 DATE
PRINT NAME:
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\I-Iandouts\Permit Application
ti
MECHANICAL' PERMIT
VALUE OF MECHANICAL WORK
s h 7C ; t, 0
! ieate how YnCMAF of each e a
to be installed or relocated as art o this raj Bct. Do not include a 'tin res to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS
OTHER (DCSFIitpej
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commercial)
r
BOILERS
FURNACES
OT WATER TANKS (Gas)
C MPRESSORS
r ]
GAS OG SETS
PIPING
M,
(Ju ` )iY REFRIGERATION SYST
WOODSTOVES
} UC'fING
�I11
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$ 4 70, 606
Indicate how many of each tqpe ❑ Lr to be installed or relocated as part of this project. Do not include existingfaWres to remain.
BATHTUBS (o Tub/shower combo) ( LAVS (Hand Sinks) TOILETS
DISHWASHERS RAINWATER SYSTEMS URINALS
DRAINS SHOWERS VACUUM BREAKERS
WATER PIPING
OTHER (Describe)
DRINKING FOUNTAINS SINKS (Kitchen/utility) y)
WATER HEATERS (Electric)
HOSE BIBBS SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
�-�� Ir-�-✓���
SEWER PURVEYOR
f��w
VALUE OF EXISTING IMPROVEMENTS
g , 76 0
�EXXISTING/PREVIOUS�USE
2wie,� 4oar 4Ld/�r
LOT SIZE (In Square Feet)
' ?) J _
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes, No
S
PROPOSED FIRE SUPPRESSION SYSTEM?
El Yes ZNo
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
E%ISTDiG PROPOSED TOTAL
Area Totals ��y+� �
**RBW HOMES ORLp■ '•
ESTIMATED SELLING PRICE
# OF BEDROOMS
FOR OFFICE. USE
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Mare Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW Bunmmo
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Xpe
# of
Stories
Additional Information
TOTAL BDILDAPG
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application