19-105744RECEIVED
PERMIT APPLICATION
CITY OF V DEC 0 5 2019
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenterfacitvof ederalway.eam
COMMUNITY DEVELOPMENT
PERMIT NUMBER t _ f � L' ; - C TARGET DATE /
SITE ADDRESS 1 ry,� � � SUITE/UNIT #
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL #
$3�lVl, �°°� 7 (a, Zjv
TYPE OF PERMIT
DING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
AIS,L) ScgTT&& 1-
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
Lc-PROPERTY OWNER
CITY
STATE I ZIP
NAME c`ti.-1i ` ��
PHONE
!t<AAIL G ADDRESS s
cLcrp
E-MAIL
t
CONTRACTOR
STATE
r(�I
ZIP��rS3
WA STATE RACTOR'S LICENSE # EXPIRATION DATE
NAME
FEDERAL WAY BUSINESS LICENSE #
- -
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY STATE ZIP
FAX
PROJECT CONTACT
AM&
PRIMARY P•1--
3, ?� " Lu 4� ` `, 1
WMLINDRWS` _
3 ` o- _
(The individual to receive and
respond to all correspondence
concerning this application)
E-MAIL
a4nh @ snr} o k bra}tt�,�
TATE
G.
JZIP
FAX
PROJECT FINANCING
E
-.�
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
When value is $5, 000 or more
(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 authorised 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 clainq, 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 oj]'lcers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: DATE I�IIy
PRINT NAM
ry)
Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OFMI;Cf�fANlCAL WORK
$ �A A -
MECHANICAL PERMIT
f Jeow MaM of each type offixture to he installed or relocated as part of this pLx1ject. Do not include existinq Axtkres to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS pas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT Is
Indicate how many of each type affixture
to be installed or relocated as
pan of this project. Do not include existing1wwres
to remain.
BATHTUBS (or Tub/Shower combo)
LAVS (H—d Sioxs)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Eieer ie)
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?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
EXISTING
Area Totals
**NEW HOMES ONLY'*
ESTIMATED SELLING PRICE
PROPOSED I TOTAL I FOR OFFICE USE
PROPOSED
# OF BEDROOMS
TOTAL
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
S_ limare Feet
Occupancy Group(s)
_
Construction
�TYpe
# of
Stories
Additional Information
_
_
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
_
Construction
T�pe
# of
Stories
Additional Information
_ _
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application