19-105394A�L RECEIVE® PERMIT APPLICATIONCITY OF
Federal Way NOV 0 8 2019 PERMIT CENTER + 33325 8� Avenue South +Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcente ityoffederalway.com
CfTY OF FE[7EAAl. WAY
EV�
- -
PERMIT NUMBER —2
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
a- A D3
PROJECT VALUAATION
ZONING
AS SSOR'S TAXfPARCEL #
$ i) / DOV,. OD
9-- — 02 0
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
� / 7-1dA)
,�!
PROJECT DESCRIPTION
�� �� '
Detailed description of work to
be included on this permit only
NAME
4w,�,Ktw
PRiKARY PHONE
mac-
PROPERTY OWNER
MAUMO ADDRES
E-MAIL
CITY
l
STA"'Ol
rr 1
ZIP
x
`
e•.�. P)V, \r —6� i�
/'�
PH i j,� 1 P2
1
V 1
Mp1l.iur_ nnrnw - \ � �
�N trl ` V V
E-MAIL
AY U]IRvtAl2
CONTRACTOR
T! A K� 11C�— M
ZIP )
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
n
NAbio **,
PRIMARY PHO E '
D ffL
MAILING ADDRESS
3a
E-MAM
s .
APPLICANT-
CITY STATE
EGE (F1V 06 W f
ZIP
9
FAX
NAME I
/
PRIMARY PH NE
4
PROJECT CONTACT
L
c2le
MAI 1NG ADDRESS
��d ��
E-MAIL
G ✓
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP &S—
FAX
concerning this application)
GvQ
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 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
information supplied to the city as apart of this application.
SIGNATURE: .. DATE
PRINT NAME:
) -60jr
r7mA
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
WORK
MECHANICAL PERMIT VALUE OF MEL $
CHANICAL
Indicate how nutny v ch type of ure to be installed or relocated as part pf this pro
ject. Do not include exfslingjUtures to remain.
AIR HANDLING UN FANS GAS PIPE OUTLETS HER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (eommerei�)
BOILERS FURNACES HOT WATER TANKS Ir.
COMPRESSORS GAS LOG SETS REI�RIGERATIO ST
DUCTING A5 PIPING WOgDS g
PLUMBING PERMIT
VALUE OF PLUMBING WORK
Indicate how many p each e o
re to be in-Q or roincated a
o thisproject. Do not include existin res to remain.
BATHTUBS (or Tub/Shower combo)
(Hand Sinks)
S WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAI
SINKS (Kitchen/Utility)
WATER HEATERS (Etectric)
HOSE BIBS$
SUMPS
WASHING MACHINES TOTAL FIXTURES
GEN INFORMATION
C�RIITIdA`L AR`EAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
—I L® I[
EXISTING/PREVIOUS USE
LOT SIZE
(In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
e ! 9
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE A CARPORT ❑
I a
OTHER (describe)
TOTAL
Area Totals
87USTJNG
al an d
PROPOSED
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application