20-101779-Building Permit Application-05-01-2020-V1A�k PERMIT APPLICATION
CITY OF
PERMIT CENTER ♦ 33325 81h Avenue South ♦ Federal Way, WA 98003-6325
Federal Way 253-835-2607 ♦ FAX 253-835-2609 1 permitcenter@cityoffederalway.com
PERMIT NUMBER — -
- TARGET DATE
SITE ADDRESS
PROJECT VALUATION
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
[CONY IVT.Tejp I[s).1
SUITE/UNIT #
ZONING I ASSESSOR'S TAX/PARCEL #
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME
MAILING ADDRESS
CITY
NAME
MAILING ADDRESS
CITY
WA STATE CONTRACTOR'S LICENSE #
PRIMARY PHONE
E-MAIL
STATE I ZIP
PHONE
E-MAIL
STATE ZIP FAX
EXPIRATION DATE UBI #
NAME 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
PROJECT FINANCING NAME ❑ OWNER -FINANCED
When value is $5,005 or more (RCW 19.27.095) MAILING ADDRESS, CITY, STATE, ZIP PHONE
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,
Bulletin #100 — February 19, 2020 Page 1 of 2k:AHandouts\Permit Application
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 apart of this application.
SIGNATURE:
PRINT NAME:
Bulletin #100 — February 19, 2020 Page 2 of 2k:AHandouts\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 OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
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)
........................................................................ .................. ..................
Area Totals
EXISTING
PROPOSED
TOTAL
Bulletin #100 — February 19, 2020 Page 3 of 2k:\Handouts\Permit Application
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s)
Square Feet
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s)
Square Feet
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Construction # of
Type Stories Additional Information
Construction # of Additional Information
Type Stories
Bulletin #100 — February 19, 2020 Page 4 of 2k:\Handouts\Permit Application