15-105245 RECEIVED
CITY OF OCTIIIP
i 2x15' ‘ 41/4
FERMI APPLICATION
Federal Way
CITY OF FEDERAL WAY
j� CDS
PERMIT NUMBER / _ / 1 S - TARGET DATE ( �i &//5
SITE ADDRESS SUITE/UNIT#
36c0li itt,T" vim S( AL- ( 'tD0 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ¢lNIRE PREVENTION
NAME OF PROJECT Fic---- k2A-6_ (A)A-Y /7 /&/i Sr/04.9 6--,
PROJECT DESCRIPTION /� 'i /
Detailed description of work to U
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER F JtxAc_ (,,,JA` Pc,'(306_ afidcA-S ,Z43—.2,kL" Lf/81
MAILING ADDRESS ..
33330 qi� /gt/t s JNLZ.a'Kt&j
CITY reD ed 2. L W I _ A4E ZIPnq„^, ^,�J 1
Ny1r19/ 5.--7-12616.776Y-1
LIJ,(� --y' /���J`'`v`/(I��IVII' PHONE / /�. `q� J
NAME )� I Slig t .V G-/2t1 7 6Y -f 15- -56 c,�'5-e S
MAILING? ADDRESS�r)/ /��j MIC-
E-MAIL
CONTRACTOR `�gclv6 o f igc1 SP, 5-re-
/US v Cl,(A ® TCLC Ci�SCAN^
CITY STATE ZIP liV - FAX
FEr 9C, 4) 3
w r 2 - !
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
1-k Ni ig'Ce.--s`'3x7C_ .7"/ /3 i/`7 15-WOi1S
NAME `1P�MARY PHONE
J S.7-/,�! tet N.ki/t�A irs-r�+ Co c- cv( s3- cf,q
APPLICANT f LING ADDRESS E-MAIL
3 3 y 00 cs'7)4- AVE- 61 sr& Icy5. Jva NA 6) TcL-ccs d,(Cy
CITY STAATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT Y
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME OWNER-FINANCED
PROJECT FINANCING
Required value of$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 supplie o'the city as a part ., this application.
r, _....
SIGNATURE: 'TA- DATE [0 /inc
PRINT NAME: Jc.,S'Tf a LEONA
Bulletin#100-January 1,2013 Page 1 of 3 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(Commercial)
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. 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
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Al4 L-A4, t.uD $ 1fr
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE PPRESSION SYSTEM?
IP ❑YesNoes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT // /
FIRST FLOOR(or Mobile Home)
SECOND FLOOR i� /F/ // 7./.4,-14/.4;"/", %j// r
/ lsi' 'X;42'1,77-/-../9„„,4';;100,7%;1;".../'
/" / --.. 9„„,4';;1 /0,7%;;r`// /r/'-,
/` � �,//Fd.,,�d'r!'=., � ...............__....._._......____....___"__.._.._.._...__..._..__—_—._.....____.__....__......
COVERED ENTRY
DECK // J ///
ti
GARAGE ❑ CARPORT ❑
OTHER(describ`e}.
,: ' .;,.:i.,i3. .,fid . ✓r'r'.,� � � .. .._.__._...___...___._......_—__.................._..___.
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEN,'BUILDING/ " L7r ,% rsf ;/! /5'tl'(., `// fish' j, y rr , ,i,
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TENANT AREA ONLY
PROJECT AREA ONLY ,/ ! /
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application