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21-100509-CO Building Permit Application
Ak c6iy or Federal Way PERMIT NUMBER PERMIT APPLICATION PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + perrnitcentenitcitvoffederalway.com TARGET DATE SITE ADDRESS SUITE/UNIT # 53 0 S. 40aD 1' l /V Fede, ra -o � 910003 J PROJECT VALUATION ZONING ASSESSOR'S TAX/PA EL # $ S gc, ©S 1 n TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION Detailed description of work to be included on this permit only PROPERTY OWNER NAME MAILING CITY Fey NAME 1,'e.► , LL C MAILING ADDRESS CONTRACTOR cl e- WA STATE CONTRACTOR'S LICENSE # NAME �re4 6' APPLICANT MAILING AD SS CITY PROJECT CONTACT (The individual to receive and respond to all correspondence conceming this application) PROJECT FINANCING When value is $5,000 or more (RCW 19,27.095) STATE I ZIP WA 6?h03 STATE ZIP �1f U/ 0 EXPIRATION DATE STATE I ZIP PRIMARY PHONE oC-y12-2yVo E-MAIL / PHONE E-MAIL FAX UBI # PRIMARY PHONE �.?, _z E-MAIL O�rG'a, r FAX NAME PRIMARY PHONE rSrf4 `GLre''c- ?_06 - 1/Z-2Y o MAILING AD SS�, ` ��11 rq+ E-MAIL / 03 73t �� J �i ,& . Q fYlC { 1f9(H GL('/ GE CITY STATE ZIP FAX w9J gPV3 NAME �n-,/� e. — /YI Av hi f L�1 OWNER -FINANCED MAILING ADDRESS, CITY, STATE, ZIP PHONE 2.06-1(12 2-Y4M 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 information supplied to the city as apart of this application. SIGNATURE: DATE 2 03 z PRINT NAME: A rV 4G Cal. Bulletin #100 — Febmaly 19, 2020 Page I of 2 0HandoutsTermit Application VALUE OF MECHANICAL WORK MECHANICAL PERMIT $ Indicate how many of each (tipe o fixture to be installed or relocated as part of this project. Do not include existiggfixures to remain. AIR HANDLING UNITS PANS GAS PIPE OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (coo,or rejap BOILERS FURNACES HOT WATFR TANKS )cas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OFPLUMBING WORK PLUMBING PERMIT Indicate how man of each type of Fixture to be installed or relocated as part of this project. Do not include existingfixtures to remain. BATHTUBS (or R,b/Sno,ver Co, bo) LAVS (U— d Sb,ks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS )K;ieber,/Unbly) WATER HEATERS (E[ect,[c) 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? PROPOSED FIRE SUPPRESSION SYSTEM? L= Yes L No ::] Yes ❑ No RESIDENTIAL —NEW OR ADDITION AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL BASEMENT FIRST FLOOR (or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER (describe) Area Totals EXISTING PROPOSED TOTAL **NEW HOMES ONLY** ESTIMATED SELLING PRICE # OF BEDROOMS FOR OFFICE USE COMMERCIAL— NEW/ADDITION AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information Square Feet a Stories NEW BUILDING ADDITION COMMERCIAL— REI I()I)EI. TENAsNT IIVIPROVl+aMEN'I`S AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information uare Feet S Stories a �7 TOTAL BUILDING �2 2J3 1 tlid TENANT AREA ONLY / 1 %rl��y'✓,C 33, t I � WOU !" PROJECT AREA ONLY 7 b CL J, J�a� r W rrLi/YnL 23 Bulletin 4100 — February 19, 2020 Page 2 ol'2 k:\Handouts\Permit Application