21-101280-Permit Application-05-05-2021-V1PERMIT APPLICATION
CITY OF
1 Wadv! iu Hll r_ i' r'sN,
PERMIT NUMBER _
PERMIT CENTER + 33325 8'L Avenue South + Federal Way, WA 98003-6325
253-8 5-2�607 + FAX 253-835-2609 + p(-rmitcenter@cityoffederalway.com
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TARGET DATE
SITE ADDRESS
SUITE/UNIT #
`�n
V9+1A V �.s. oo
PROJECT VALUATION
$ -�' o t 0 G 0
ZONING
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ASSESSOR'S AX/PARCEL#
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TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
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\j
be included on this permit only
PROPERTY OWNER
NAME
PR�I7MARY PHONE "70
MAILI1qG ADDRESS
E-MAIL
CITY
a%A
STATE
ZIP
q 60 '
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UHI #
N
PRIMARY PHONEZ
MAILING ADDRESS
E-MAIL
we rae�, �
APPLICANT
CITY
l AJ
STATE
V%
ZIP %
l
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is .$5,000 or more
(RCW 19,27.095)
MAILING ADDRESS, CITY, STATE, ZIP
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 arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
d to the city as a parttof this application.
information suppli�Z&
f
rRSIGNATURE: LOLi7L DATE _ 6 WJ 17
PRINT NAME: ajA,� c t `L ' c k—a r
CCfV
Bulletin # 100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT s
Indicate how many of each type offtdure to be installed or relocated as part of this project. Do not include existing 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
s
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing 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 X No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes QK No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
.........................................................................................................................................................
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
3 i t
(1j
.........................................................................................................................................................
SECOND FLOOR
COVERED ENTRY
.........................................................................................................................................................
DECK
GARAGE ❑ CARPORT ❑
..............................................................................................................................
I ..........................
OTHER (describe)
Area Totals
EXISTING
PROPOSED
41(o
TOTAL
**NEW HOMES ONLY**
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 BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin # 100 —February 19, 2020 Page 2 of 2 k:\Ilandouts\Permit Application