20-105087 - BROWN - SF-ApplicationPERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8t' Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + l;ermitcente ncityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
�C; l C(
PROJECT VALUATION
ZONING
ASSESSOR'S TARIPARCEL #
C F! _7 a 2—
?I -q t c� c- — o C1
TYPE OF PERMIT
BUILDING 1�d PLUMBING �[ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
h CIF c.Lf�`iL
PROJECT DESCRIPTION
Detailed description of work to
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�.
be included on this permit only
NAME
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PRIMARY PHONE
"Ikv5v6-��1't
PROPERTY OWNER
MAILING ADDRESS ��
E-MAIL
CITY
VIAL-
STATE
WA--
ZIP
L t�- �J
NAME
PHONE
) h 7 �y�y ``
t/' L i "b 5- ivi:. N' �f'� 2--- fv i ►'Ny- W �t i L � � N (k-, °..
g 7 •e"• � ,
MAILING ADDRESS '-(�'l L, 4—
E-MAIL
ti' I'tl
CONTRACTOR
t=
'a•
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
USI #
�C K
' �7
NAME �{ -1
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
r
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perfury 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. 1 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 apart of this application.
SIGNATURE: li �+/�/li�•--'� DATE
PRINT NAME:
Bulletin # 100 - February 19, 2020 Page I of 2 Ul-landoutsTermit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
,
Indicate how numy of each type offixture
to be installed or relocated as
part of this project. Do not include existingfixtures
to remain.
AIR HANDLING UNITS
_/�FANS
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commercial)
BOILERS
FURNACES
HOT WATER TANKS (Gag)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
VALUE OFPLUMBING WORK
PLUMBING PERMIT
$
2 100, 00
Indicate how many of each type offixture
to be installed or relocated as part
of this project. Do not include existingfixtures to remain.
BATHTUBS for Tub/Shower combo)
�� LAVS (Hand sus)
TOILETS i `F"y..(y�]
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
_7 SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
�� SINKS (Kit en/Utility)
WATER HEATERS (Ekctxw)
HOSE BIBBS
SUMPS �_
WASHING MACHINES
TOTAL FIRTURES
GENERAL INFORMATION
CMICAL AREASON PROPERTY?
WATER PURVEYOR
T
SEWER PURVEYOR ,1;
VALUE OF E7Q8TIIVG 0ROVEMENTS
ID
OD
1-r—
L.is, j/ � �'C
$ '^ P- s W
E7a8TING/PREVIOUS USE
LOT SIZE (In Square Feet(
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes A No
FROPOSE33 FIRE SUPPRESSION SYSTEM?
❑ Yes X" No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
1�j/A.
—_...._..._._._._._.... .......... _ _........... - --.......-_----•--
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
N�
COVERED ENTRY
.2
1 1.1-
DECK
GARAGE CARPORT ❑
441 1
�v `
`T h
OTHER (describe)
Area Totals
EX36MG
P°PMR°
i
**imw HOMES 19LY**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area is
Square Feet
Occupancy Groups)
Construction
# of
Stories
Additional Information
NNW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENAPIT IMPROVEMENTS
AREA DESCRIPTION
Area in
S uare Feet
Groupie)
Occupancy 1
Construction
Type
# of
Stories
Additional Informn atio
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\iandouts\Permit Application