17-102650 RECEIVED
A i, . A' 17 PERMIT APPLICATION
CITY OF JUN U 2 20
Federal WayPERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
TY OF FEDERAL
DEVELOPMENT 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
I - "v 07 6 v -- FP
PERMIT NUMBER" - _
(' -
TARGET DATE
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 000* v 9 z I o yam _ 9 2 -1 I
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING A..FIRE PREVENTION
NAME OF PROJECT MUD w D P t 2-2\rA
PROJECT DESCRIPTION i `
Detailed description of work to Lol-�V �
be included on this permit only
NAME PRIMARY PHONE
C-e-►ki e-C P -612}) L+L,C- 2vz QII 264-5
)
PROPERTY OWNER MAILINGADDRES E-MAIL
a�z r -V1 st Jo ►�1( e
CITY STATE ZIP}�
eP- -F2 ; (c�Ya Glgl2Z J -.. , `�F5 unm
il
i f� ? 17 PHONE
J/L'7 r IN ADDRES3"�ri>C7 O� E_ L
CONTRACTOR *` s-
•TY STATE
• STATE CO T OR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
al 1p(-� G_I �i K 6i1cOlzd5
NAME PRIMARY
PHONE
in
&)IOV 1 1134-CD
Pre-AC-Pre-AC- M_C.l iPl"`lD
• APPLICANT- MAILING ADDRES E-MAIL
14-b2., S�" flnAr-1 c�-.U5.COIN(\
_ ST' ATS ZIP �1 � 2F/A"Re-AA �
NAME PRIMARY PHONE
PROJECT CONTACT m PVC-A - t t7 1000J31 I Z 39-5
(The individual to receive and MAILING ADORES V , E-MAIL
respond to all correspondence .\-vL. e i ,N2- fl t -c-.05•(nrv\
concerning this application) CITY STATE ZIP FAX
c5c'�A-}4-Pre- LIZ)--n Ci?)i lag, ioZ4-)
PROJECT FINANCING NAME tkOWNER-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,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 . r- ci . a part • •is application.
SIGNA�T - DATE Coot-)
PRINT NAME: `M - ' i
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
$
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of project. not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS
this PIPE OUTLETSDo OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
I VALUE OF PLUMBING WORK )
PLUMBING PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of project.Do not include fixtures tremain.
BATHTUBS(or Tub/shower combo) LAVS(Hand Sinks)BATHTUBS existing WATER PIPINGo
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS{Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
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 ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
/r rr� r S r rr irir r / i rrfr e ftp
,,'",,,,,,,„:.;..4/ it f/ ,,;,/,� /.,,..,.0.,••. r' •c%`F u,rru� r`, �r �r, #'r ` „_, ,..",14. 04,...-.4,4',,v..s /., , ,•""1',� _ ................................___......................
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
"' ;,,'`f r .M Z F 1,d ' ,a .4m.,,,,,40,-',/,,e1,, !,,`��%,ee r�`�; ;,;.kf/ ' r ,,
✓ er rr N r f ,,.'s r s,r",^%'' ^r' 'y '>,' sr �F/, / f, ,:fr '�` ,,''s,
,,,11;„'14-
il" a`'tiro.. `r`r "`. '`,` 1:'-; r ;0"0:1};#4,,,,- -e4 'd:,fi r' ate' e �.....: ...._...._......._.._.._............._.._...........
GARAGE 0 CARPORT 0
, ' , f.:_, J ./ ij,!o`9
;,,,,f� f y �/e-4:/2•,,,,--
rr ✓Nj1 / r; , % r// f� /� �r „j� � § rA �f/ a ya�p1� i ' r,71� �, PROPOSED TOTAL0,1. Te,PI',,,X15., ' rf, EXISTING
...._...................._........-'-..-_...-.-.._.._..............-.................................._.........._................._._..._......_......._......._............................_............_..........................._...._...
Area Totals
`y y,ra,' i ,ria' �"",r. , ,r) a b"r ,''ark ,r !r .r�r e;F?.! ..
% /4' ,F;�44$.• iir'i....--,•,-,,,,,, ,f� .�•i., ,....9„d 8 ,.>e,:r, „ ,,•,,,4,-.,,/
..,i !!.^i,•,r/ '.: ,�';
•
ESTIMATED SELLING PRICE$ I # OF BEDROOMS
COMMERCIAL—
NiEW/ADDITION
) Construction inFeet Occupancy
"fTis :. ' i`'":'
,, AdditnaInfom io,..n
0AREADESCRIPTION Snuarg,. Wei,'
% , , r , l ;, # ff I.r.,ri ,fdJf rff 'r,`/y/' r1 ' •
// , i ! , „1 , ..r s , I4 %' . (, .!„ / j :r; i zee,''''”, Iy �r,..,,,,,,,,,,,,,,,,,,,,r.,4", , yr, i %;” I
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
S ware Feet a Stories
,.,.<,. ."> v"i s: .. �, �".' ,s>. y .: �'" rr" vr'ft' ,;. `if, r r",,''
ill",//4".
,� B,, ri/, r/i,, /` 1; r� , ,,4s': . f J',,- f rr ?
TENANT AREA ONLY
14,-...1:•,,;;41:7'-'4°
rrrr, �` .+/'''r, -Jr; 1i`r',,:or / r. 4—•,,,:,,,,,,
� ' '',� .! ,', ;"' `"� ,�,
�f ,.,'' ok �f ,;' /,, •`r ^ ,%ri ; .',G"�'/ /, r ,,, r' y",.; ,+�`r3,'
,, r,,, ted✓ S' 9i'.r ,c', ,,' i . -� ✓ �;r f p A° gCi: .,
F,'�',�.y",' ,I*' -,;;..r,/%:,,,, /f„„t,.`"„!-' ,.�r"r.: . '��,.,r�.> Yf✓✓••---',- ,/./ vols ,i,,,.�, Fr ..,,. �'�.�,. `r '�.r.'/q e•'.� ,hr's% 1. .riF.'.'” ,y r,F.
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application