12-101866 CITY OF :;r. /�
Federal Wa' 6_ I HERMIT MF CO ME PL DE EN \
�MMUNITYDEVELOPMENT SERVICES APR P L I CAT I O N s L Z - 'o
253-835-2607•FAX 253-835-2609
yrww,dt o ederalwau,cont
CITYQF FEDERAL WAY
SITE ADDRESS CDL^ • SUITE/UNIT#
J -Pi130/_\ii
.13
PROJECT VALUATION ZONING ASSESSOR'S T PARCEL# 9 a ..2-(,.
TYPE OF PERMIT
D BUILDING ElPLUMBING ❑ ECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT(Tenant Name/Homeowner Last Name) f ,t
taafteea
PROJECT DESCRIPTION OUTTY-(
"4_,4(447
444--
Detailed
description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER 1
'mac _lc ' 1 - I , u, l ___ -6605
MAILING ADDRESS E-MAIL _
`
! ',,,2_, t �.-t-k�� ..
-
Th STATE
CITY( ZIPg)eil-vg v.)414 \j N- i Ob 3
NAME C /� l l/f l Sl!i(.f�t�Z�-1 '^'_ W C ii, E 9 0 T St o e "
MAILING
(ADDRESS E-MAIL
CONTRACTOR (\�\
CITY �\ J STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ ''''(,___,/
PHONE
NAME r ' \►J A )LJ "\--4"_ILYA -r',..,--v-L` •?-. 5, -Ip61 '1°Z1----1oa .
APPLICANT MAILING ADDRESS E-MAIL
Cn 2 �� 1 L- Itie� �wj Ari a,.1 ciy S' S'vAeirtM w, \J'OAvIQS_ J.A
CITY ` STATE Z _. FAX �C��_t _�.r.
PROJECT CONTACT NAMi< - - �- PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS ,E-MAIL
concerning this application) , )L- 1'iC-1`l t-L -(9,,,,k,..,3,76_, mac' , ,,,,,,0 c U)r(,c v - 7‘ou
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required value of$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 arises 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.
(Lk,
SIGNATURE: °, �r DATE
PRINT NAME: () d-k+ r..---k/L.O. ,
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES 1$
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No E Yes ❑ No
..,-e-- � � $ tea t,4 g� r :
_ ' . u l 44
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
109S4i I r x ' n
FIRST FLOOR(or Mobile Home) = ----- -- --
C74430145,7 ;45!::
AWIFM
t, 4 J
COVERED ENTRY
GARAGE 0 CARPORT ❑
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ # OF BEDROOMS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in S•uare Feet .e Stories
ADDITION
AREA DESCRIPTIONIIINEN Occupancy Group(s) Construction Stories#of
Additional Information
"t;,,,ifteativiitim; t40941'0211
TENANT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application