19-104997RECEIVED
I PERMIT APPLICATION
CITY OF OCT 16 2019
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
Federal Way CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
COMMUNf1Y DEVELOPMENT S F T
PERMIT NUMBER I _ _ LJ L� — S F TARGET DATE ,
SITE ADDRESS SUITE/UNIT #
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT VBUILDING ❑ PLUMBING NAFCHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
0 V
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 19.27.095)
MAILING ADDRESS
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CITY�� a�
NAME i 1 �i•-,r�/
MAILING
ZIP
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PRIMARY PHONE
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E-MAIL
PHONE
C STATE I Zl I FAX
WA STATE CONTRACTOR'S LICENSE #
NAME
MAILING ADDRESS
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CI
NAME
MAILING ADDRESS
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CITY ^^((77JJ^7 ��i�frif •l�J
f
NAME
MAILING ADDRESS, CITY, STATE, ZIP
STATE I ZIP
EXPIRATION DATE I FEDERAL WAY BUSINESS LICENSE #
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R
STATE ZIP
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P PAARY PHONE
cry Z3y
E-MAIL
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PRIMPNY PHONE .�
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E-MAIL
FAX
❑ OWNER -FINANCED
PHONE
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 ,Iaeo out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ty as a part of this app;ieatlon.
SIGNATURE: - I
PRINT NAME:��
Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ -7 6 6 v
Indicate how many 2t each type offixture to be installed or relocated as part of this pMLect. Do not include cams nq fl=res to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
is
N I I�A-
fndicate: how many of each !WLe affixture
to be installed or relocated as
part of this pro' Do not include existin2 fixtures to remain.
BATHTUBS (or Tub/Shower combo)
LAVS (Hand sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes ❑ No
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
EXISTING
PROPOSED
TOTAL
**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 FeetType
Occupancy Group(s)
Construction
es
Stoof ries
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application