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21-102726-Building Permit Application-7-6-21-V1CITY OF FederfW Way PERM T RTv>sa ER PERMT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + permiteenter@cityoffederalway,com — -- �— TARGET DATE SITE ADDRESS C b % G� S' SUITE/UNIT # PROJECT vALUATION ZONING ASSESSOR'S TAii/P CEL 0 TYPE OF PERMIT © Bu DING ❑ PLUMBING © MECHANICAL ❑ DEMOLMON ❑ ENOINEERING ❑ ME PREVENTION ICE OF PROJECT 9` PROJE4--'I' DESCRIPTION s ,tJ ® J -� Detailed description of work to be included on this permit only NAME PRIMARY PHONE ]PROPERTY OWNER + �s r C s ~ ' M/ CI STATE ZIP 90 I v NAME _ ,,// CLU,jP-J PHONE + U 406R MAILTKG RESS E-MAII, OONTRACTOR CITY � &TAR); zip FAR (j/!J, 6' WA STATE C ONTRACTOR'S LICENSE 0 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE t NAME PRIMARY PHONE y rL� APPLICANT OtG REss r-M IL CITY STATa ZIP i154 lam gAg PROJECT CONTACT IIAME PRIMARY PHOWS I (The individual to receive and MAILING AE 0REs9 s-MAIL respond to all correspondence concerning this application) CITY STATE ZIP FAX , ��. PRO,gEC',C FINANCING/Vj❑ NAP, OWNER FIPdARCEi3 When Lrcdue is $5;000 or more (iRCW I9.27.095) HAILING Al DRESS, CITY, STATE, ZIP PHONE I car t% under penalty of pert fury that I the property owner or authorized agent of the property owner, I certify that to the best Of mr,I knowledge, the information submi"ed in support of this permit application is true and correct, I certify that I wilt comply u9th all applicable City of Federal Way reguratio insPertaining to the work authorised by the issuance of a permit, I understand that the issuarcce of this permit does not remove he owner's responsibility for compliance with Iota; state, or federal laws regulating constrtection or environmental laws. Jr ftcr-gher agree to hold harmless the City of $Vderal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such clain4. which may be made by any person, including the undersigned, and filed against the city, but onir-v where such claim arises out oft reliance of the city, including its offlcers and employees, upon the accuracy of the inform ion supplied to the city as apart qj this application. SIGN,A'rURE DATE PRINK` VAME; ej -A) Bulletin # l! 00 —January 29, 2016 1 Page 1 of 2 kMandoutsTermit Application vALUE OFAWHWCAL WORK FANS GAS PIPE OUTLETS V FIREPLACE INSERTS _ HOODS Icommewn FURNACES HOT WATER TANKS Ica GAS LOG SETS REFRIGERATION SYST 6AS PIPING WOODSTOVES OFPLUMBING WORK RAINWATER SYSTEMS -- WATER PIPING URINALS OTHER(Deacribe) SHOWERS VACUUM BREAKERS SINKS (m m/unu'gl WATER HEATERS (mc° 3UMPS WASHING MACHINES TOTAL F=uRES APOA DESCREPTION (in square feet) INN FIRST FLOOR (or MobUe Ho�) COVERED ENTRY • � � itliq - rr TENANT AREA OIiLY Occupaaoy Groups) Ocoupancy Groups) FOR OFFICE USE Additional Information Additional Information Bulletin #100 —January 29, 2016 Page 2 of 2 k:�iiandouts�Permit Application