21-100836-Building Permit Application-3-2-2021-V1CITY OF '
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenterircityoffederalway.com
— — — -- — — — — TARGET DATE
SITE ADDRESS SUITE/UNIT
J� �ry `
LAIbf J-� �� 0 (' ��J
PROJECT VALUATION
ZONING ASSESSOR'S TAX/PXRCEL 0
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION i1 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work tobe included on this permit only
PROPERTY OWNER
NAME
8 ~ S 7-r-
PRIMARY PHONE
w u fo vz
MAILI G ADDRESS
x1of S.
EMAIL
9CI Y /'
! �
STATE
044
ZIP
G� Ci
NAME fy
/C� ' ..
PHONE /ff
MAILING ADDRESS
I-0
E-MAM
CONTRACTOR
CITY
STATE
,,�, /,'Pj
ZIP
162? C'
gA1F
,s -
WA STATE CONTRACTOR'S LICENSE @
EXPIRATION DATE
FEDERAL WAY i3USINESS LICENSE 9
NAME
t
PRIMARY PRONZ pp
e� D yip
%fAiLING ADDRESS
CP � a'aQ �
Fp�L
-l- K
APPLICANT
CITY
STATE
ZIP
FAX
_ 4
NAME
PRIMARY PHONE
PROJECT CONTACT
J
2. C 4� -,6 "
(The individual to receive and
respond to all correspondence
MAILING ADDRESS
d �5
E-MAIL �
✓Iin
concerning this application)
CITY
STATE
ZIP�`
FAX
PROJECT FINANCING
NAME
f/Illr
❑ OWNER -FINANCED
When value is $5, 000 or more
(RCW l9 2ZO95)
MAILING ADDRESS, CITY, STATE, ZIP
PRONE
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 oert(N 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.
A
SIGNATURE; DATE i
4
PRINT NAME; L
'E'v
:W1
Bulletin #100 -January 29, 2016 Page i of 2 kMiandolltAPerrnit Application
MECHANICAL PERMIT ddVALUE OFMECHANICAL WORK
Indicate how MEny o each type offixture to be installed or relocated as arto this ro ect. Do not mcllude esistin res to reml
__ AIR HANDLING UNITS PANS
� AIR CONDITIONER FIREPLACE omGAS PIPE OUTLETS
® BOILERS OTHER (Describe}
® LACE INSERTS HOODS ICoerctaq
FURNACES
® COMPRESSORS HOT WATER TANKS (Gas) GAS LOG SETS REFRIGERATION SYST
® DUCTING GAS PIPING
yy
gg WOODSTOVES
PLUMBING PERMIT VALUE OF PLUMBING WORK
Indicate how man o each t e o re to be installed or relocated as art o this ro ect. Do not inciade existing BATHTUBS IorT b/sn rco=" LAVS (Hinds s) res to remc
DISHWASHERS-- TOILETS _ WATER PIPING
__ RAINWATER SYSTEMS URINALS
DRAINS
SHOWERS OTHER (Describe)
® DRINKING FOUNTAINS VACUUM BREAKERS
HOSE BIBBS
SINKS (aunm/,, 0 ty) WATER HEATERS (Emw;.)
e_ SUMPS
® WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPEATYP WATER PURVEYOg
SEWER PURVEYOR VALUE OF ER[STINo Uaunn�
pn Squaze
FIRE SPR[NKL61
❑ Yes ❑ No
11dE3IDENTIAL - NEw oR EDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home) A�
J� SECOND FLOOR
FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (dcribe))
Area Totals BX STIXO PROPOBRO TOTAL
►iY7S1
TENANT AREA ONLY
Ocoupanoy GroaPls)
FOR OFFICE USE
Additional Information
Additional Yaformatioa
Bulletin #100 —January 29, 2016 Page 2 of 2
k:�t-Iandouts�Permit Application