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C,TY OF ,11111111III
► PERMIAIPIWW4PON
Federal Way
SEP 0 2 2015
PERMIT NUMBER l 5 _ ( 0 4 4 S1-_ ±]E TARGET DATE CITY OF FEDERAL WAY
— — — CDS
SITE ADDRESS 33-70a 1 4v-e_ S i i SUITE/UNIT#
F C Ic 4, (A)a . C 023
PROJECT VALUA'FLON / ZONING ASSESSOR'S TAX/PARCEL#
$ 1750` 930 ( 00 _ 00 ( 0
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING WPIRE PREVENTION
NAME OF PROJECT ` j— M 'e(e
PROJECT DESCRIPTION
--
Detailed
q c,_ f) -ei 1 nye ra- Prost ) - 1D2 Pt S�,pNsS
Detailed description of work to '5 y 5 G 1 , --e ,epe c ovwcoirC[c j coo At().3 ci`
be included on this permit only ! 1 J
NAME ���j� Q� PRIMARY PHONE
PROPERTY OWNER si;-'i/ktIAM> 1
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAMsI.' JGn PHONE
2,D -31,10-4i3IN
MAILING AD.. ES k v......t j E-MA:e ..
CONTRACTOR 2i°b i r c)r— a- S t S X 11 le saGan sq�e•am
CITY `� /lf T STAt ZIP (fin. i 20KT _ 3,1
/_3z! I
WA STATE CONTRACTOR'S LICENSE# jn�• EXPIcRA • DATE FEDERAL WAY BUSINESS LICENSE#
SAIJVic.S,2_40R.O 6 / . 4'/
PRIMARY
NAM bick iorN 2S 3 PHONE
Mt1 /
MAILING ADDR_ S ti t E-
APPLICANT Wt el,l Dr, MC C l 5 mectiVe &.5<lli e M
CI5i
STA
TEK.` ZIP(,/i^8 Li2 I FAX
z 6-341-0-y yoj
NAME �j PRIMARY PHONE
PROJECT CONTACT Ct JQ ue. C c 5€( 2.4 -3(40--g36b
MAILING ADDRESS1 C E-MAIL (
(The individual to receive and ` o r ,5�c 6'e e S Sckce,aim
respond to all correspondence
2�w r� otr" 4 J
concerning this application) e c.,, � Si;AE ` ZIP g e 1 6 C l/ aFA (� 3 Lib-41301
NAME vv 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 Iaws 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- ch claim), w ich may be made by any person,including the undersigned,and filed against the city,
but only where such claim aris s •ut of t ± - ••nce of the city, including its officers and employees, upon the accuracy of the
information supplie• to ti =city •part•-is app I •tion.
SIGNATURE: %,444,dAl t' •/ _� DATE Cl/2/1
14
PRINT NAME: G G r b tie ikn
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 OFF EXISISTING IMPROVEMENTS
V -i\‘:\ $ 1it;rc
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSEDYFIRE SUPPRESSION SYSTEM?
❑Yes❑ No `N4;Yes ❑ No
70-61 ( kn (ul'n
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
A 'i r„i„/!„//: „ rfj'fr/rt l/�f/ ft,f .,,;+,.,rFr: •
FIRST FLOOR(or Mobile Home)
r
COVERED ENTRY
DECKS % / /% /
„3 ,;, ,, �a/ ,,.<;,.,.Fo,,-� ', ,.
/
GARAGE ❑ CARPORT ❑
{ ,crIbe /
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
,, �ii i'/� /��.r�i/�/�'/!> v; l�/ri �� ,/ �/`i��y”
.
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
if ,_/wf/j %' ,'',/ //,./ 'raj/., ,,- % ✓'
TOT Ot
TENANT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application
