21-101324-Building Permit Application-04-16-2021-V141k
CITY OF
Federal Way
PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter,icityoffeclerakvay.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT p
3 g 1 o 4 f ! -5f PL 5
FAA d'dr I OOk-% Q,4 Q Sod 3
4- G
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL N
� 79
Rix Z�f00
3 2 2 2 L-
1---V
TYPE OF PERMIT
❑ BUILDING ❑ PLLFMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
I" — ❑�r
4 15 "
r L44YVl WS y CCIJ
f )4v5
PROJECT DLSCRIPTION
r 5
E
AVL4
Detailed description of work to
-
1�G- Y i. l� f G a rs a rit. IrG fit 5 .2420
be included on this permit only
NAME
PRIMARY PHONE.
T573 -202-- S 2-
PROPERTY OWNER
MAILING ADDRESS
EMAIL, .
37
1a,7 lvdt ha�m�l
CITY
STATE Z[P
W!� 9$ob3
NAME . 5 Pb4 Se trvpra d
�+G
PHONE
r . - 5 4,
ZO&- 282-GJSaO
MAILING ADDRESS
o S 2o9f1 S� Sl,�kc W-101
EMAIL
SGrvprdccnfr
CONTRACTOR
CITY
STATE
WA
ZIP
9 163 2-
FAX
ZS3-277--7G1 S-
WA STATE CONTRACTOR'S LICENSE /
EXPIRATION DATE
UBI 0
Cc SERVpC5 9 l l LE
UG i o s izov
Goz-4$7- 3q
NAME
PRIMARY PHONE
Yn l,Ke- E i rI r'
O 2.3 - L1 �L3 $
APPLICANT
MAILING ADORES
13320 s 2os f>~ 5� St�I �� { -for
EMAIL 54Lry rocenfra.l
P 1 ,ri
,. aAf
CITY
ke.��
STATE
WA
ZIP
q-�03Z.
FAX
253-27'1-74-15'
PROJECT CONTACT
NAME
M iICL- F t vt P.
PRIMARY PRONE
20io- z 3- V438
MAILING ADDRESS .� [r
'q 3 S Stet � �
E-MAIL �,rv�>ra C r
(Vie individual to receive and
respond to all correspondence
D o2&g I T-1
! eeci J`( a syt
CITY
Yz�k
STATE
w
ZIP
98r13 z
-
FAX
.253 �� - 76 rs
- --
concernutg this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
LVhen value is $5,000 or nrore
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
tl?ClV 19.27,U95J
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 Wormation submitted in support of this permit application is true and correct. I ccrft that I will comply with
aIt 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.
[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 c ty as a pXis appticatiort.
SIGNATURE:
DATE
f �Z
PRINT NAME:
BLLUCtin 11100 - 1-cbruary 19, 2020 Page 1 of 2 k:%landOLRSTcrmit Application
VALUE OF MECHAMCAL WORK
MECHANICAL PERMIT
Indicate howl nuuty of each type of ftxture to be installed or relocated as part of this pwject Do not include eidsting fttures to remain
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe(
AIR CONDITIONER FIREPLACE INSERTS HOODS (comet )
BOILERS FURNACES HOT WATER TANKSa.)
_ COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF FLUMBA'G WORK
PLUMBING PERMIT
$ 0
Indicate how rnany of each type offbcture
to be installed or relocated as part of this project Do not include ezts ' to remain.
BATHTUBS (or cab/Sho rcombo)
LAVS(H.m smwe
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER( Describe(
_ DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (lard../uub,n
WATER HEATERS (a r)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIBTUREs
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
NEWER PURVEYOR
VALUE OF E USTMG IMPROVEb ENTe
EEISTING/PREVIOUS USE
LOT SIZE (Ia sq swe Feet)
MUTING FIRE sPRINRLER SYSTEM?
PROPOSED FINE SUPPRESSION SYSTEM?
❑ Yes Di� No
❑ Yes XNo
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
7-2-
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
Zx 2
"NEW HONES ONLY**
PAu�t 1/�e-v
�_ _/. _ _ _. t\ ..
ESTIMATED SELLING PRICE $ 1)
#OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUIDING
A arrioN
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Typa
# of
Stories
Additional Information
TOTAL BUILDING
750 x 2
��M
1 I161,t '
14,
2-
TENANT AREA ONLY
75-D
PROJECT AREA ONLY
2.7 1. 2-
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\PIandouts\Permit Application