19-104912 (2)L4q*k&t DECEIVED PERMIT APPLICATION
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OCT 11 2019 PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + erinitcente rrtit yoffederalkray.COm
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER I q — /i� V q ( — M_F TARGET DATE Ct,10 tAo I q
SITE ADDRESS
PROJECT VALUATION
$ -7
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
j7lvr individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is $5,000 or more
(Rcw 19.27.095)
ZONING
M
SUITE/UNIT #
Wh IZC70- C
3OWS TAX/PARCEL #
_L__& i a 0 1- D o A�
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME
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MAILING ADDRESS
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CITY STATZ �7�I WA ZIP vos
NAME L' V��V'� 1 CF/YIS'`r
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MAILING ADDRESS
E-MAIL
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FAX
WALLSTATE CONTRAACT 'S LICENSE # EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
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NAMEe,h �JN,f f`
Park
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PRIMARY PHONE
a�S.>�1I_NOS,
MAILING ADDRESS
E-MAIL
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l ,�� ❑ CITr STATE Z,IyP
FAX
NAME (� �
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PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY STATE ZIP
FAX
NAME Pro r Ow L
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, SIP
PHONE
I certify under penalty Of perlury 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 applicatian is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by he is lancecal, o tatpermit. I andral ratanows thatulathe
issuance of this permit does not remove the owner's responsibility f compliance
ing
construction or environmental laws.
[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 a part=thispPpltcatian.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 -January 29, 2016 Page 1 of 2 BHandouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each [
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
wure to be installed or relocated as
FANS _
FIREPLACE INSERTS
FURNACES _
GAS LOG SETS
GAS PIPING
PLUMBING PERMIT
Indicate how mazW of each type a axtlere to be installed or relocated as
BATHTUBS (or Tub/Shower Combo) LAVS (Hand Sinks) —
DISHWASHERS RAINWATER SYSTEMS
DRAINS SHOWERS —
DRINKING FOUNTAINS SINKS (Kitchen/Utility) —
HOSE BIBBS SUMPS
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet(
I0j O-01 (1)
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'"
f this project. Do not include existulgjlxiures to remain.
GAS PIPE OUTLETS OTHER (Describe)
HOODS (eoaunereisi)
HOT WATER TANKS (Gas)
REFRIGERATION SYST
WOODSTOVES
VALUE OF PLUMBING WORK
(('this proiect. Do not include existing rxt res to remain.
TOILETS
URINALS
VACUUM BREAKERS
WATER HEATERS (Electric)
WASHING MACHINES
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ �5-c
EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes)( No ❑ Yes X No
PROPOSED I TOTAL
PROPOSED
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
anc
Area in Occupancy AREA DESCRIPTION S uare Feet P y Group(s)
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s)
9 uare Feet
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
TOTAL
FOR OFFICE USE
Construction I# of I Additional Information
Construction I # of ` Additional Information
Tvne Stories I
Bulletin #100 —January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application