21-102829-Building Permit- 07-13-21-V1CITY OF
Federal `UU'ay
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentel@cityoffederalway.com
PERMIT NUMBER _ _
— — TARGET DATE
SITE ADDRESS C 1� r
V20
SUITE/UNIT #
O 9 6J �P%S k I `i+- 'J�c� I`rj- w
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCiZL #
TYPE OF PERMIT
❑ BUILDING PLUMBING 5t MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
1 �t �• � cr~
'206) 22 `1 1 i l -¢
PROPERTY OWNER
FAILING ADDRESS ss Q
t71r1? 1�
E KAIL
'�4y1c��«�GILI GtQ
C
F�--1Y-a' w
STATE
wck
ZIP
QO
NAME
PHONE
j
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
H cwtf-'
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
MAKE
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When vahte is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
tRCW 19.27.09s/
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certfy that to the best
of my knowledge, the 1r;Jormation submitted in support of this permit application is true and correct. I 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
Wormation supplied the-citg as apart of this application.
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SIGNATURE: DATE
PRINT NAME
Lv ^
Bulletin # 100 — February 19, 2020 Page 1 of 2 k:\Handouts\Pemut Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type effpgure to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS C FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (caB)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$ 2GnE)
Indicate how many o each type offixture
to be installed or relocated as part o this project. Do not include e;dstingfixtures to remain.
BATHTUBS (or Tub/Sho—r Combo)
LAVS (Hand Sinks) �—
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (IIirebea/utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
N. eGtire-y)
VALUE OF =8TING IMPROVEMENTS
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
11c.� �
EXISTING FIRE SPRINKLER SYSTEM?
❑ YesNo
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
QS &7TOtO
PROP09®
**MW HCMM
O.Ywr►
ESTIMATED SELLING PRICE
I # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NNW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application