21-101845-Building Permit Application-5-13-21-V1PERMIT APPLICATION
C TV OF '
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PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcentel@cityoffederalway.com
FiERMT NUMBER
— _ TARGET SATE
SIT& ADDRESS
+
SUITE/UNIT 9
PROJECT VALUATION
ZONING
ASSESSOR'S TAXjPXRCEL#
TYPE OF PERMIT
❑ B0;
ZING ❑ PLUMBING ❑ MEcRANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION Detailed description of work to
be included on this permit only
NAME
PRIMARY PRONE
FF d
PROPERTY OWNER
MAIL aAD
A113f
3RESS
S.
E•MAII,
egy
STATE
ZIP
_ELIOA:
WA
00
NAME
PHo"
w+�nn.ING
RF98
g'# -ry-
$-IdAIi.
CONTRACTOR
C�
sTAT�
L,,'�iT'
ZIP
c
FAX
..
WA STATE C
ONTRACTOR'S LICENSB $
EXPIRATION DATE
FEDRRAL WAY BUSIRESS LICZNSZ t
NAME
A.114+
PRIMARY PHONE
RI ss
E.MAIL
APPLICANTrna
CITY
-T "A e-rl
STATE
1,1414 lam- T7
ZIP
FAX
SAME
PRIMARY PHONE+ IM
PROJECT CONTACT
, ! er
MA MG At
4e.,,'j6
DRESS
E �'
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FIRANCllgG
NA
❑ OWNER FIINANCED
When value is $5,000 or more
iRCW 19.27.095)
WAU,Ifip AT
DREW, CITY, STATE, ZIP
PI{Omr,
I aertW under penalty of perjury that I c
m the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the information submitted
all applicable City of Federal Way regulati
issuance of this permit does not remove the
construction or environmental laws.
in support of this permit application is true and correct. I certify that I will comply with
ins pertaining to the work authorized by the issuance of a permit. I understand that the
owner's responsibility for compliance with local, state, or federal laws regulating
I further agree to hold harmless the City
the investigation and defense of such claim
but only where such claim arises out oft
information supplied to the city as a part qj
9
of Federat Way as to any claim (including costs, expenses, and attorneys' fees incurred in
which may be made by any person, including the undersigned, and filed against the city,
reliance of the city, including its offleers and employees, upon the accuracy of the
this application.
LSIGNA'PUREI
OATS
PRINT NAWZ* •� ;
[:
Bulletin #100 —January 29, 20I6 1 Page 1 of 2 k:lIlandoutslPcrinit Application
Indicate he ;E.ynany• each •- •
- • •- r -• •relocate•
r• • ••- I• • r--
AIR HANDLING_
PANS
. - to remain,
AIR CONDITIONER
FIREPLACE INSERTS
GAS PIPE OUTLETS OTHER (Describel
BOILERS
FURNACES
HOODS (�� .. j4
COMPRESSORS
GAS LOG SETS
HOT WATER
DUCTING
•AS PIPING
REFRIGERA77ON SysT
WOODSTOVES
I•
1
SIDENTIAL =NEW OR ADD!
AREA DESCREPTION (in Square feet)
._ ••
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
•
KsLuLqm r-
OF c ••••
roil
' • .. •�.
Bulletin #100 —January 29, 2016 I Page 2 of 2
k:V-IandoutsU'ennit Application