21-104661-Building Permit ApplicationPERMIT APPLICATION
CITY OF
PERMIT CENTER + 33325 8w Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityofiederalway.com
PERMIT NUMBER -1 - / 0— -�- 1 —('�7 1 - S � TARGET DATE (1 - '7A 2-1
SITE ADDRESS
SUITE/UNIT 1
1-d P& 5uw j-
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCE
$ Soo
TYPE OF PERMIT
I BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of ulork to
f
be included on this permit only
NAME
PR13ARY PHONE
PROPERTY OWNER
-
MAII.DNO ADDRESS
3
STA
ZW 0�3
MAILING ADDRESS
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E-MAIL I
CONTRACTOR
CITY
BTAT$
LN14
ZIP /L r
FAIL
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WA ROMATE CONTRA UC' .
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1, I � TE
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NAME
PPAKARY PHONE
- v 5-
MAILING ADD
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APPLICANT
CITY
STATE
WA
o S
FAX
FA
NAME
RRUCART MOM
3
PROJECT CONTACT
LV1/lG_
KADLMG ADD
Z-ALAIL
(The individual to receive and
respond to all correspondence
CM
STATE
ZIP
FAx
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When ualue is $5,000 or more
(RCW 19.27.095),.,,
MAILDUG ADDRESS, CITY, STATE, ZIP
F o23
PHONE
Icy - 2�
I certify under penalty of perjury that I am the property owner or authorised 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 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.
Zfurther 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 parson, including the undersigned, and filed against the city,
but only where such claim arises of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the of a of thiss aapplieation.
SIGNATURE: DATE l 2 7i l
PRINT NAME:
Bulletin #100 - February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
IL ON
MECHANICAL PERMIT VALUE OF MECHAMCAL WORK
$
Indicate how many of each type of ftxture to be installed or relocated as part of this project Do not include eidstingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commemiaq
BOILERS FURNACES HOT WATER TANKS (cu)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT
'OF PLUMBING WORK
$
Indicate how many of each type offixture
to be installed or relocated as
part of this project Do not include exist'eidsting fExtures to remain.
BATHTUBS (or Tub/shower Combo)
LAVS (Hand Swu)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Mchen/Utllity)
WATER HEATERS (mectric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FD[TURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXIBTDITG EmanwVEDIENTS
$
EX[ ITING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTZK?
pROpOSkD FIRE SUPPRESSION 9YSTZW
❑ Yes ri No
-i Yes -) No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
E33STING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobde Home)
SECOND FLOOR
COVERED ENTRY
DECK
UD I
J
GARAGE ❑ CARPORT ❑
—
OTHER (desca fi*
Area Totals
NZISTO'°
PROPOSED
I Ob
TOTAL
30 O
--
e19" $GRIM GIYLT**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Groh s
P P()
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Grou •
P P(1
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Iandouts\Penmit Application