09-104687 R
CITY OF A PERMIT SF MF CO ME EL PL DE EN(FP
Federal Way -s_0 1 2009
COMMUNITY
53835-2607`FAX253-835-C$OPMEIVT SERVICES
OFFEDE�n, •PLICATION -�` -,
www,cituottederalwau.com
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PROPERTY � .�,„- ; e it ;
SITE ADDRESS
La ;._ , :z�: 1 .% Al
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#/r //C`/(C i
/; 111
ii
PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name) T\kC CIA-0'2C.t4 c)p (3L€---ss C
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING 6ij FIRE PREVENTION
00 1=n€ ALAnaq DE Ors—EJ _D.– r — t.+” Tr A}t..41-)
PROJECT DESCRIPTION 1-1--g' ,k- ' a- JTO AN Cv..IS i 6 PCfL' PA►-/E
Detailed description of work to
be included on this permit only
PEOPLE
NAME PRIMARY PHONE
✓yam--��I ''l.. -- lJ :4,...4---,.....L....4,-4."
PROPERTY OWNER (ZPi ) 2)2- - 1)-7 i
MAILING ADDRESS,CITY,STATE,Z E-MAIL
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT D PROJECT CONTACT
NAME PRIMARY PHONE
� e s-i-sraiAs kAleST (2 C 3 ) S'2A - a.0
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
SO
4
ack- t_ %:.. ;kc (10 K.; .tv%–e( P&i ( L5'3) �3 s- 0 L'3
Y ATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME Cov .` PRIMARY PHONE
APPLICANT ( ) _
MAILING ADDRESS,CITY,STATE,ZIP FAX
( )
PROJECT CONTACT NAME PRIMARYPHONE
(The individual to receive and -Y-cAotAo ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE.ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: I r PRIMARY PHONE E-MAIL
L ) -
_-
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS.CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27,095)
( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arise ..ou. o the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t . ' . • par of •is application.
lib1
SIGNATURE: ®� DATE
( I ;u I : X.
PRINT NAME: . 1:(10N1 J -Ci PE Trvorsbc
Bulletin#100—4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
' • S
MECHANICAL FIXTURES
Value of Mechanical Work$ __ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type offixture 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(cos)
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(orTLb/Shower Combo) LAYS(stand Sinks) TOILE lb 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
(PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
F� � ti�- y . u(am $
E 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
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION Area OccupancyGroup(s) Construction #of
in Square Feet P( ) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS _
AREA DESCRIPTION Area OccupancyGroup(s) Construction #of
in Square Feet p( ) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/21/2009 Page 2 of 4 k:\Handouts\Permit Application