HomeMy WebLinkAbout15-100884 0
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city OF FEB 2 5 2015 PERMIT APPLICATION
Federal W ay
CITY OF CDS RAL WAy
PERMIT NUMBER / 5 _ / V/ ! X g 7 _ F-�
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TARGET DATE
SITE ADDRESS SUITE/UNIT#
Zo��
S. 3YY� sr. F� 2i+t'I- v�`C, t- A A-4
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
z/cao" 2 (o 1 3 3 0 - 0 0 0 J
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING kIRE PREVENTION
NAME OF PROJECT GevOA tAA r u/.-st'me
PROJECT DESCRIPTION ucolt_Detailed description of work to 1400 IN`e-s►o�(S .j si µA.et✓ One 22e...0%• 4.-.0( "Q I O colt.. (ll/La
be included on this permit only c 0 r 4 N(_.-4,) rt ooc YS-e.%el-
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NAME PRIMARY PHONE
PROPERTY OWNER (,a. &.,ft_ yt�
.
MAILING ADDRESS( l E-MAIL
tv)o S. 3 YYta' f4- eef-
CITY STATE ZIP
revs-•te.t w vt 59Q'-3
NAME 1 PHONE
P4--Cat oT tf -e-e- 'i - i 1 • 253-52`-2250
MAILING ADDRESS E-MAIL
CONTRACTOR Z7U"t -nick An/L e:--- .,o�.�nGier�J :IQ•few--
CITY STATE ZIP FAX
Tilt Cdv',.AI ti-A- 'xY?y 2s3-in-4/SD
WA ITATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
AyrL, FPc drICF to / 5 i /(o ll-1- I°19$8-oo-I6c�
NAME tt PRIMARY PHONE
NAME,.
As CeAdre.c 4,f
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAMEPRIMARY PHONE
PROJECT CONTACT J 0' '- Date ti 757 zy y-34fe7-
(The individual to receive and MAILING ADDRESS E-MAIL (�^
respond to all correspondence ,17Will'0Will' MILS �� JA. gt Yiorll'�ife.Clk'
concerning this application) CITY STATE ZIP FAX
...614'e 0•4•-* IA1A- 14142-`( ZS5--y22-4(S0
NAME
PROJECT FINANCING FL OWNER-FINANCED
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 supplied to the city s a pa of this application.
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SIGNATURE: `�J��- DATE 2-/2 y/)-S----
PRINT NAME: J�� _ 0&.tt•%_
Bulletin#100-January I,2013 Page I of 3 k:\Handouts\Permit Application
14.
• •
VALUE OF MECHANICAL WORK
IVTECI-IANICAL 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(commeroiat)
BOILERS FURNACES HOT WATER TANKS)Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
I..UltTBING 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) LAYS(Hand Sulks} TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Ki(chen/Utility) WATER HEATERS(etctr )
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes❑ No ❑Yes›:(No
7fo«Ye
RESIDENTIAL - NEW OR ADDITION
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 UNLIT`
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COINIMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COI'I MiERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDING; q r
TENANT AREA ONLY ' � S(i/ f�V/'as 1
PROJECT ONLY :'`
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application
