21-104778-BuildingPermit ApplicationCITY OF
FederaPVVay
PERMIT APPLICATION
PERMIT CENTER + 33325 8h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitventeCUcityoffederalway.com
PERMIT NUMBER
TARGET DATE
HITS ADARE//85 / ( I SUITE/UNIT #
PROJECT VALUATION
ZDSQIIIG
AS ESSGR'S TAX/PARCEL #
?
l
TYPE OF PERMIT
(J` 1u,PING ❑ PLUMBING Q MECHANICAL ❑ DEMOLLTICN ❑ ENGINEERING ❑ FIRI: PREVENTION
NAME OF PROJECTYA
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit. only
NAME y %
�' Vv V ' ��,I
PRIMARY PHONE
"''
PROPERTY OWNER
MAILING ADDRESS
3 4l 'vv' J
E-MAIL
Q�,ll "
CITY STATE ZIP
PHONE
MAILING ADDRESS
R-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
uEt #
NAME a y
(IZ, r Q J� avt—. t
PRIMARY PHONE
^�7
APPLICANT
MAILING ADDRE W
34 T� w�`( �
E-MAIL /
A 9
.
CITY �� �� ST ZIP �
i� � g a a
FAX
NAME,
Loa .I
PRIMARY PHONE
PROJECT CONTACT
(Tine individual to receive and
MAILING ADDRESS
, 3 .�-� J' I'j
EMAIL
�
respond to all correspondence
CI STATE ZIP ' , -7
FAX
2i3
mncernuig this application)
,f LC C vJ
PROJECT FINANCING
N E t 0� 11 Qjc
OWNER -FINANCED
When value is $5,000 or raore
(,RCw 19.27.095)
MALLING ADDRESS, CITY, STATE, ZIP
FROM
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner, I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
Issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim orris gout of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tot %tty part of this application.
SIGNATURE:
PRINT NAME: ! "'
DATE � 3 -2A �I
titI 'WiA,
Butletin #100 — Febmaty 19, 2020 Page I of 2 LUIandoutsTennit Apphcalion
VALUE OFMECHANICAL WORT{
1VIECFIANICAL PERMIT /V 'A$
Indicate how manti orvd6h type o re to be installed or relocate s part of thisproject. Do not include existing fixtures to remain.
AIR HANDLIN NITS FANS GAS PIPE OUTLETS OTHER (Describe)
_ I AIR COONER FIREPLACE INSE S HOODS (ccmmer«aI}
B RS FURNACES HOT WATER TANKS (G—)
COMPRESSORS GAS LO ETS RFFRIGERATION SYST
DUCTING GA WING WOODSTOVES
VtS
PLUM SING PERMIT LUE OF PLUMBING WORK
Indicate how many of each type of fixture to be installed or relocated as part o this ro ject. Do not include existirkg fixtures to remain.
BATHTUBS jo 1'v6/s@a ve com 3 LAVS (Handsinksj TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SBOWERS VACUUM BREAKERS
DRINKING FOU AINS SINKS (Kitchen/Utffi WATER HEATERS (6lectric�
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR r
-� (�
S WER PURVEYOR p
[[
VALUE OF PJ=TZNG IMPROVEMENTS
cb s STY i ck
�- sP.11. 54) C -
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
I l
B� .6
❑Yes No
ElYes � No
4 fjnn
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXIST pRKPOSED TOTAL
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
wr _
,
GARAGE ❑ CARPORT ❑
Area Totals ;'
EXISTING PxSSPo3f'.P�
TOTAL
.
ESTIMATED SELLING PRICE $. # OF BEDROOMS
FOR OFFICE USE
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
Type
Stories
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
a
Stories
€€
TENANT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\14andoutsWermit Application