21-100627-Building Permit Applicationz-
PERMIT APPLICATION
CITY OF
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcentel@cityoffederalway.com
PERMIT NUMBER �J R _ I 0 6 Z _ (V\ 1-
- TARGET DATE
SITE ADDRESS
SUITE/UNIT #
51� to z3�� �� E
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
/ 0 o o
h Q
I Z { 1 t - _! 0
TYPE OF PERMIT
NBUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
�%t �1 ttl lit t l i°.. e31 'i' i, Gr'. ItL - Ct• �rT �.N W Pr I, L PATGM I
PROJECT DESCRIPTION
tcli,�1' dnJ tll>i-2ATG 1 fL �.JiktmL 3��N(r CvT O� p5L1t,1.><D �dtC
Detailed description of work to
✓A.I '-A 1. L.. C9 F P L W '- L-r, c r-1C A 1— L/ v.io IC F g W ,4S4+Z IC P—E'i—m o
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
355 FL S-r-Z:IO
E-MAIL
CITY
Sho 131elro
STATE
CA
ZIP
q17-tI
NAME
f(E50J%c1E9 IAIC
PHONE
Zo6-60--79-iq
MAILING ADDRESS
/W3$6 KE0MOND W46f
E-MAIL
C�tssFM Ll. �1
CONTRACTOR
CITY STATE
1CJrD `004rJ WA
ZIP
9't�v5'Z-
FAX
WA STATE CONTRACTOR'S LICENSE #
3vt��R1`i�9�c>3
EXPIRATION DATE
0e /Zot
UBI #
g6�a
NAME `
-,L S4�m e lid Co+.+T2orc r4Si
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY 7STATE
ZIP
FAX
PROJECT CONTACT
NAME
C,lr 1 `7 S'
PRIMARY PHONE
206, —(.U; — '74
MAILING ADDRESS
A- Suer— AC' cc^-+°rrp-^vr®M
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
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 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 tootthe as a part of this application.
�city
SIGNATURE: (/ V` DATE ;Z I % ho Z I
PRINT NAME: tz 1 f 'CA sr E
IL
Bulletin # 100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed 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 INSERTS HOODS (commerciai)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many o each ttjjoe offtxture
to be installed or relocated as part o this project. Do not include existirkg fttures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
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?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin # 100 — February 19, 2020 Page 2 of 2 kAl-IandoutsTermit Application