21-103632-Permit Application1
CITY OF �F
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + germitcenter( cityoffederalway.com
TARGET DATE
SITE ADDRESS
3 4S,zi PA G � �.s� ...��, , wr/fW
SUITE/UNIT 4
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL 8
$ � 2? 0,03, Q-3
TYPE OF PERMIT
k-aUILI)ING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
7 ;4 P— P�41 L R.aS \DVr9 (t f -f-
Z 4 0 .3'P. T I. 1 "
PROJECT DE5CRIPTION
Detailed description of work to
be included on this permit only
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NAME Al 3r i Jam. S- LLC-
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDYESS
E-MAIL
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NAME c e n � n; ,
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ONE q n
MAILING ADDRESS / L�
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- AIL
C-aAIL 42-4
CONTRACTOR
CITY v�
12 cS �.'a
STATE
21
FAX
WA STATE CONTRACTOR'S LICE NS H
C
E RATION DATE
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P IMAR P NE
7 323
MAILING ADDRE S �/ (�1
121z7 � . 3 i 6 c�T J� /4•3
MAIL
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APPLICANT
CI _ . I
Q-'/-�..�.�
STATE
ZIP ,p 3
FAX
T '
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Ll
PROJECT CONTACT
NAME
��
PRIMARY PHONE
(The individual to receive and
MAILING ADDRESS
EMAIL
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value iS $5,000 or more
(RCW I9,27.095)
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 Iocal, 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 a pyptq this application.1*
' /
SIGNATURE: DATE inF} 20
PRINT NAME: *A!4 S
Lx-,,,
Bulletin ##100 -- February 19, 2020 Page 1 of 2 kAIIandoutslPerinit Application
VALUE OFMECHANICAL WORK
MECHANICAL PERMIT
Inasare now many or eacti type ot ttxture to be tnstalled or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE I RTS HOODS (c...e jap
BOILERS FURNACES N HOT WATER TANKS
_ COMPRESSORS GASLOG REFRIGERATION SYST
DUCTING _ IPING WOODSTOVES
PLUMBING PERMIT
VA LUE OF PLUMBING WORK
Indicate how many of each type o ature to 4e installed or relocated as part of this project Do not include existing ttGares to remain.
BATHTUBS LAVS ( aSi I I
DISHWASHERS RA�VgTE
DRAINS SO
DRINKING FOUNTAINS KS (K;tch—/uenrty)
HOSE HIBBS SUMPS
TOILETS WATER PIPING
48�I, URINALS OTHER (Describe)
' VACUUM BREAKERS
WATER HEATERS (Eiaw.)
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
/NCB„ .
WATER PURVEYOR
,�v.: I "- , J J -: �
SEWER PURVEYOR
e-e...'�_ d — C� L- ``��
VALUE OF EXISTING IMPROVEMENTS
� Ir
EXISTING/PREVIOUS USE
noq A rQ o M1..�Y
INEW
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes ❑ No
PROP08ED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
RESIDENTIAL - OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Hom
................_.._ ................... _.._.._................... —_........................ - .... ...
SECOND FLOOR
COVERED ENTRY
�.
.__.._.... ............. _..... _..._............... _._....... __...................
DECK
................. _._..__._............................. ...................................... ....____........
GARAGE ❑ CARPORT ❑
OTHER (describe)
........... ........................... _......... _................... ___.___._.................._ .
Area Tot s
ExIsrlNa
Paoros
rornL..........
..... ........ __..... .T.__.._.—_____......____..._........
••NEW H0=S ONLY•"
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Construction
a
R of
Stories
Additional Information
NEW BUILDING
A!
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
A
AREA DESCRIPTION
Arein Feet
S uarea
Occupancy Group(s)
Con
Typeetion
of
Stories
Additional Information
TOTAL BuumNG
TENANT AREA ONLY
/2 . s x f
'J
V _ (5
PROJECT AREA ONLY✓
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application