HomeMy WebLinkAbout15-103718arYoc PERMIT APPFTION
Federal Way CIVED
I �
PERMIT NUMBER l _ FF JUL 2 8 2015
_ TARGET DATE CITY OF EF:D€PA 6 i n in nom_
r`Inr
SITE ADDRESS
SUITE/UNIT #
e ra I Gc9a Lli fi q6023
I
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ �, 73 1, o C
Iq l & le - o& s 3
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING M -FIRE PREVENTION
NAME OF PROJECT
; V6k 'FeSI deNc f
r PA 130 f4l2c
PROJECT DESCRIPTION
Detailed description of work to
Z ! to r o S F F—
be included on this permit only
PROPERTY OWNER
NAME
Get r r
PRIMARY PHONE
MAILING ADDRESS
Z30�l SW 36�/�. g}
E-MAIL /�
SPGMlefeveef#ylyll.tow�
CITY
Fedi,,,, W
STATE
WA
ZIP
980.7-3
NAME
PHONE
etervi StA}e5 FJre
c/25 6's 1- 6i0o
MAILING ADDRESS
E-MAIL
lylaw M6 95 t� 5f to l
err , c+i`nQ! K5
CONTRACTOR
CITY
STATE
ZIP
FAX
Rcd n A
9 86 z
1`125 881- 30 30
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE Y
106 ES
l2 -q9-10(QN7b�oo-gL
NAME
Sarno A5 Ce>7fra,_+e�'
PRIMARY PHONE
MAILING ADDRESS
EMAIL
APPLICANT
CITY
STATE
ZIP
FAX
NAME
Sa Con frac fie
PRIMARY PHONE
PROJECT CONTACT
y
MAILING ADDRESS
EMAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
54 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 T11
PRINT NAME: Y D r r<
Bulletin #100 —January 1, 2013 Page 1 of 3 kAHandouts\Permit Application
i
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include exist!Uftxtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial
BOILERS FURNACES HOT WATER TANKS (oar
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
EXISTING/ PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
$
Indicate how many of each type of
flxture to be installed or relocated as
part of this project. Do not include existing
fixtures to remain.
BATHTUBS (or Tub/ Shower combos
LAVS (Hand sink.(
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 K No
< Yes ❑ No
Bulletin #100 — January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application
