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21-102728-Building Permit Application-7-6-21-V1
PERMIT APPLICATION CRIV OF PERMIT CENTER $ 33325 81h Avenue South f Federal Way, WA 98003-6325 Federd Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoflederalway.com PERMT NUMER TARGET DATE SITE AnDRM 5 7— y �,{ S f —[�- 6ITITFiIUNI'F # Ll %—[" 1601154t lw� Z- q -z— PROJECT VAMUATION ZONING ASSESSOR'S TAX/PARCEL # TYPE OF PERMIT ❑ BU IIING ❑ PLUMBING © MECHANICAL ❑ DEMOLMON © ENGINEERING ❑ FIRE PREVFNrioN NAME OF PROJECT PROJECT DESCRIPTION Detailed description of work to ✓� � � �+ be included on this permit only HAMS PRWARY PHONE 5-S Z- <? - PROPERTY OWNER GAD RESS Ems, d rn �. CI STATE ZIP v NAME _ PHONE MAILINGDRESS �` Sj- � E-MAIL' CONTRACTOR CI-7, AX P WA STATE C ONTRACTOR'S LICENSs ! EXPIRATION DATE FEDERAL WAY Buenms LICENSE A NAME PRiidARY PHONE e'erXQ�� APPLICANT IHGAZ V(0 01IMS 108 E-MAIL CITY i STATE ZIP FAX r PROJECT CONTACT NAME cry PREV"Y PHONE _ z-6 (The individual to receive and MA mGAE DRESS a-MAM respond to all correspondence 4 !s concerning this application) CITY STATE ZIP FAX kly-OLU PROJECT FINANCINGH AbM All ❑ OWNER FINANCEI] When value is $5, 000 or more (RCW 19.2ZO95) MAILING AE DRESS, CITY, STATE, ZIP PHONE I certt fy under penalty of perjury that I am of my knowledge, the information submiite the property owner or authorized agent of the property owner, I certify that to the best in support of this permit application is true and correct, I certify that; wilt comply with all applicable City of Federal Way regulatio ins pertaining to the work authorised by the issuance of a permit. I understand that the issuance of this permit does not remove construction or envirpnmental laws. he owner's responsibility for compliance with local, state, or federal laws regulating I further agree to hold harmless the City of Federal Way as to any claim (including c0sta, 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 oft reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part qj this application. 4 SIGNATURE: —PATE 7 l PRINT NAi1IE• • .� V, Bulletin #100 -- January 29, 2016 I Page 1 of 2 k:lHandoutslPermit Application i f gig CON -Indicate how DITIONER .. UNITS BOILERS COMPRESSORS DRAINSDISHWASHERS DRINKING HOSEBIBBS . • m,7C AREA DDSCREPTioiq (in square feet) FURST FLOOR (or Mobile Rome) Go ■ am 021 tj MT. YAutEOFMECHAMCAL FANS GAS PIPE OUTLETS OTHER (Describe] FIREPLACE INSERTS HOODS �ce�ert>dl FURNACES --.. HOT WATER TANKS I024 GAS LOG SETS REFRIGERATION SYST GAS PIPING WOODSTOVES VALUE OFPLUMBINO WORK RLAAVIEof ♦ewcurea as part of znts pro /eci Do not includ_e e_xisting fixhtres to ren NWATER SYSTEMS — WATER PIPING __ URINALS OTHER (Describe) SHOWERS __ VACUUM BREAKERS SINKS fm/Ua¢y9 � WATER HEATERS (El/ruiq SUMPS WASHING MACHINES TOTAL FDtTulm ❑ Yes ❑ No � ❑Yes ❑ No t I -� Allcc / �„ AdditionLai Information Bulletin #100 —January 29, 2016 Page 2 of 2 k:�Handouts�Permit Application