09-103149 111 ° ? - I ° 3 / �-9
CEIVFPERMIT �� SIMF CO ME EL PL DE EN GED
Feder
lt/fA;C
COMMUNITY
253-835-26070 DEVELOPMENT ? APPLICATION
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unurucitycffederalwaq.corn
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SITE ADDRESS
krc iA- otArrr I oine, .N? ` /300 SW eamto(AS 6r.
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
/ ?' 2 / 01- _ C3' zS-
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NAME OF PROJECT
.----
(Tenant
(Tenant or Homeowner Name) p r C>,i/ r6`- / CL )f)h Carne,
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION
p/ e_I ii) 12 KSI/4 a.n kt/off -6 i _ peurte I tio/
PROJECT DESCRIPTION
Detailed description of work to /
be included on this permit only 1 2 Voll- ,)1 A/ s r!ry' /2P ' h %C�j �-1 5' a� ,
J7 ' 1 �- J
NAME PRIMARY PHONE
PROPERTY OWNER fire.a a, Tow kw Me-S (253)0� - f 94 0
MAILING ADDRESS,CITY,STATE,ZIP "� E-MAIL `]�'
13C0 5VJ (U),1i p rAS 15 r 6 dem,(
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT I 0 PROJECT CONTACT
NAME PRIMARY PHONE
Fro It, A-(a fm Super, Inom. ( ) -
MAILING ADDRESS,CITY,STATE,ZIP Q�I Q 7t FAX
Of- CONTRACTOR l
`Yi(Ocrr
WA STATE CONTRACTOR'S LICENat# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Fte 0Gt t„,f4 12..--1,- / / 0/ / 0 10,--cig -1 0 s-00 e_
NAME PRIMARY PHONE
APPLICANT ( ) -
MAILING ADDRESS,CITY,STATE,ZIP ( FAX
l )
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and ( 1,(t,,) S') -- - /96 %
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: ( PRIMARY PHONE E-MAIL
l )
PROJECT FINANCING NAME
El OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19 27.095) ( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
t
SIGNATURE: 1 _, nl v DATE (� ._ "0/
/ /
PRINT NAME:
I
f✓ &V 0 cl 6 7' yak
Bulletin#100—8/13/2009 'Pale I off k:\Handouts\Permit Applicationppllcatlon
11 4
MECITANICAL FIXTURES
f."
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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
PLUMBING
FIXTURES
Indicate number of each type offixture 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 TOTAL FIXTURES
GENERAL INFORMATION
RMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 3/ 0D-- $
EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
CO 1
COMMERCIAL -- N /A_ IT / 1
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—8/13/2009 Page 2 of 4 k:\Handouts\Permit Application