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Home My WebLink About15-102938 / CITY OF PERMIA1PPLICATION Federal Way PERMIT NUMBER/5, o/ .f � /- / 3 i_ JEL TARGET DATE (- --J SITE ADDRESS 9// SUITE/UNIT# A9Ca (P is ,. S PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# 5� 5o0 ca -7 `f 6 - U ( I "7 TYPE OF PERMIT .0 BUILDING 0 PLUMBING 0 MECHANICAL ❑ DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION NAME OF PROJECT < VIA air r S�('r"f' ()(C �� 3 PROJECT DESCRIPTION V `��V Detailed description of work to A.A. be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER }��/ 01O(, -P(� `f MAILING P.�3DRESSv E-MAIL g 9 62j, /r -f CITY STATE ZIP F24) NAME PHONE OtOIA14 MAILING ADDRESS E-MAIL CONTRACTOR CITY STATE ZIP FAX i WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / NAME atAt-PA PRIMARY PHONE APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME 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 0 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 as a part of this application. SIGNATURE: DATE "-')_T-- IS PRINT NAME: C-----7\-; K.t / , 1<`'L L- 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 oft his 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 EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes 0 No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE FIRST FLOOR(or Mobile Home) s 0 I � } �✓ �r /✓i i , i✓/F ✓✓✓/ �i �� moi ✓ f✓ ✓ �./ COVERED ENTRY I1 , ✓ ✓ GARAGE ❑ CARPORT 0 EXISTING PROPOSED TOTAL Area Totals io s°ter ; 1477,,,M, ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL-NEW/ADDITION AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories /i✓ "' +S,,„ �I7 i„'i✓. %✓, ,' !„ ��f,i✓;�✓✓ ,✓; r r,/i i,�/; "f✓ ;.air' i'',`/,✓ ADDITION COMMERCIAL-REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories ('/ �z✓, ,i ��x��, ,. ,, /,.,,'�%j�f /{ iii f i ✓ ” � �''/`�`.,, � - ,„r✓'r TENANT AREA ONLY PROJECT'AREA ONLY t Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application