21-102727-Building Permit Application-7-6-21-V1 (2)�✓Y
CITY OF "'` PERMIT APPLICATION
Federal Way PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + PAX 253-835-2609 + permitcenter@cityoffcderaJway.com
PERMIT NIIffiTiER
TARGET DATE
SITE ADDRESS
p� SUITE/UNIT /
PltOJEGT VALUATION J= CT � �� 3 7
$ ZONING ASSESSOR'S TAX/P CEL e
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIREPREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is $5,000 or more
(RCW I9.2ZO95)
NAME
ZIP
PRIMARY PHO
NE
PHONE
MAILING ADDRESS �
CITY
EXPIRATION
-
C FAX
G �
WA STATE CONTRACTOR'S LICENSE#E]
RATION DATE FEDERAL WAY BUSINESS LICENSE @
NAME
— PRIMARY PHONE
j
LING ADDRESS !a •�
CITY _U
STATE ZIP
FAX
NAME
PRIMARY PHONE J
a
MAIL[JIG ADDRESS
[a Ire
r p
CITY STATE ZIP J
�,�� FAX
NAME` � 4r _ _1�1 V,
/All1 ❑ OWNER-F`II�iANCED
MAiLiHG ADDRESS, CITY, STATE, ZIP
PkIONE
I certify under penalty of ped dry 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 Wag regulations pertaining to the work authorised by the issuance
Issuance of this permit does not remove the owner's responsibility for compliance wiof a permit. I understand that the
state, or federal laws regulating
construction or environmental laws. th local,
!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 of and employees, upon the accuracy r the
information supplied to the city as apart of this application.
PRINT NAME:
Bulletin 4100 —January 29, 2016 Page 1 of 2
k:lHandoutslPermitAPplication
MECHANICAL PERMIT VALUE OF MECHANICAL WORK
Indicate how ManY of each tife o re to be mstalled or relocated as art o this ro ect. Do not inc�de
exfstin res to rem
AIR HANDLING UNITS ® FANS
® AIR CONDITIONER ® FIREPLACE INSERTS GAS PIPE OUTLETS OTHER (Describe)
BOILERS FURNACES HOODS (cI,,C eq
COMPRESSORS HOT WATER TANKS pe,)
DUCTING — GAS LOG SETS REFRIGERATION SYST
® GAS PIPING ,,,,,,,,,„_,,,,__
A LvIVABJNNCi JCE%eiralT VALUE OFPLUMBINO WORK
Indicate how man o each type of III to be instatied or relocated as part of this ro (or Combo)
'ecf. Do not ineltpude existingres to rem
® BATHTUBS LAVS
�e DISHWASHERS (Rana sv® TOILETS
__ RAINWATER SYSTEMS __ WATER PIPING
DRAINS _s URINALS OTHER _— SHOWERS (Describe)
® VACUUM BREAKERS
® DRINKING FOUNTAINS —_ SINKS
HOSE BIBBS SUMPSwI�anlu�m ® WATER HEATERS (merrc)
WASHING MACHINES TOTAL FIXTURES
CaENERAL, IN&'oIt1VIATION
CRITICAL AREAS ON PAOPERTva m..,.e.....�.—_.__
- -' I w]' SIZE (1a Sgnaze Feet) EXISTING F[RE SPRINIn,ER SYSTEffiP PROPOSED FIRE SUPPRESSION
❑ Yes ❑ No ❑ Yes ❑ No
12 s�ENTIAL Is oR �mITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT: FOR OFFICE USE
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area TotQYIS =$iMG PROPosec �
**NBWJTOMS ondr*
ESTIMATED SELLING PRICE $
# OF BEDROOMS
C®MMEIacIAi, — l�EvaJA�DITION
AREA DESCRIPTION Area in
S uare Feet Occupancy Groups) Construction # of
NEW BUILDING Type Stories Additional Information
ADDITION
COMMERCIAL — REMODEL)TENANT 1WROVEMENTS
AREA DESCRIPTION Area in
S uare Feet Occupancy Group(s) Construction # of
TOTAL BUILDII a Stories Additional Information
TENANT AREA ONLY
Bulletin #100 —January 29, 2016
Page 2 of 2
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