17-104719 RECEIVED PERMIT APPLICATION
CITY OF
201?
Federal Way OCT O 3 PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY
M OF FEDERAL WAY
MOO
PERMIT NUMBER� _ ���
lll���Cr
TARGET DATE
SITE ADDRESS SUITE/UNIT#
4315/S Z- -` L' L TEl d is t 4,--41 ' /a '—
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$
�_
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERINGla FIRE PREVENTION
•
NAME OF PROJECT lnn 0 a, 4 a,y y- S'a,(0v. ...
L�
PROJECT DESCRIPTION
I)i .,7 QA.• s' RP.t.).e. /11 Al
Detailed description of work to A7 iAt"JL1 f
be included on this permit only
NAME PRIMARY PHONE
r
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME Y G/�.Es7 r' ,,'111 -,," --ft746-1--- PHONE 25'3—C.? —499 1
MAILING ADDRESS C�lG� E-MAIL d,
CONTRACTOR t)6 !""* ! ` �p��T�V 1 4 z-o
CITY STATE ZIP Q yrr F
L_2.2.10 [15 f I
WA ATE C NTRACTOR'S ICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
v p 42 7.�-- - / 1) 17
NAME PRIMARY PHONE
/ 15'S' $:;— .Z5 -1r7— f 1
APPLICANT AILING ADDRESS /) E-MAIL �J�yy,q
.346* ids -z--2-Ai 5Pge7-Kltr�0)/414:T1
CITY SiJTAAT ZIP 1 �y F43L ��,
N E PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ 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, 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.
SIGNATURE: .03.--› -- DATE )6/2.b
PRINT NAME: c'S S s ,AE,.-1^
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 this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe).
AIR CONDITIONER FIREPLACE INSERTS HOODS(comci
mersi)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Da 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(Ellectric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR I SEWER PURVEYOR I 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) I EXISTING I PROPOSED I TOTAL I FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑ I
1 OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ I # OF BEDROOMS 1
COMMERCIAL—NEW/ADDITION
Area in Construction # of
AREA DESCRIPTION Occupancy Groups) ,� ,,,,, S+Dries Additional Information
Crluure Feet �
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
a
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application