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21-102992-Building Permit Application-7-21-21-V1
PERMIT APPLICATION CITY OF `lam "Tv �j PERMIT CENTER + 33325 8+h Avenue South + Federal Way, WA 98003-6325 t� derd Way 253-835-2607 + FAX 253-835-2609 + Fermiteenter@cityoffederalway.com PZRbnT NUMBER TARGET DATE SITE ADDRESS U �� _:rz y w s SUITE/UNIT # PROJECT VALUATION ZONING ASSESSOR'S TA//R/P CEL # 'HYPE OF PERMIT ❑ BO DING © PLUMBING ❑ MECHANICAL © DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION Detailed description of Mork to ✓� ,t� / � be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER LEPULUWAD REss cI COT,TE ZIP L ell I arj NAME PHONE MA LMO AD DRESS gl-0 E-MAIL o CONTRACTOR -� CITY � STA'r� ZIP FAR - WA STATE C ONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE i NAME PRIMARY PHONE %dkINa AD DRIWS APPLICANT CITY STATE ZIP ]rAX v _ NAME PRLMARYPHONEY PROJECT CONTACT , (The individual to receive and MA ma Ar DREss P MAIL respond to all correspondence 9v d Sl y concerning this application) CITY STATE z(�I'.P FAX 7 i J p� y , Td �i.✓�. PROJECT FINANCING AME IT/ 0 OWNER -FINANCED When value is $5,000 or more 19.2Z o95J MAILING At DOESS, CITY, STATE, ZIP PHONE(RCW I cart( fy under penalty of perjury that 14 = 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 regulati ns 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 the Investigation and defense of such claim of Federal Wag as to any claim (including costs, expenses, and attorneys' fees incurred in which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out oft reliance of the city, including its offlcers and employees, upon the accuracy of the information supplied to the city as a part oj this application. SIGBiATUR&: -- —� DANCE Z I2 FRINT IG J Bulletin #100 —January 29, 2016 1 Page 1 of k \11andout0ermit Application VALUE OFMECJiANICAL WORK FANS ®.a GAS PIPE OUTLETS OTHER FIREPLACE INSERTS HOODS (C6z=Ud q FURNACES HOT WATER TANKS. Icy_ GA3 LOG SETS REFRIGERATION SYST GA3 PIPING wnnnemnvvc VALUE OFPLU1xgIN0 LAVE (x�a sr�,l -_ TOILETS __ WATER PIPING RAINWATER SYSTEMS URINALS OTHER (Deacribel SHOWERS VACUUM BREAKERS SINKS Iramw/uwry7 WATER HEATERS (e�.o-;� SUMPS __ WASHING MACHINES TOTAL BL4TIIRE; re feet) TENANT AREA oxcr Occupancy Groups) I Construction I * of Additional Information ' TBO® RPnvina Bulletin #100 —January 29, 2016 Page 2 of 2 k:V-Iandouts�Permit Application