21-103311-Permit Application-12-2-2021-V1CITY OF A111;k PERMIT APPLICATION
PERMIT CENTER +33325 8" AvcFLIC South + Federal Way WA 98003-6325
253 83?-2607 + FAX 2�3 835-2609 + permitcetiter(ii,citvoftcdcraly, ay.com
13F.R.NM NUMBER
IARCEI D1I
- - - - -
SFI1'EA AI f #
SITE A)/D RQESS
I RO.IF, F,'ALi A:H&N
"l.OtiING - -
.ASSESSOR S T WARCEI. #
TYPE OF PERMIT
13111.1)lvc
X I'lu vI vi f_1 Mt_cll:vlcaI, Cl I)I:vaolrn .o\ f_1 I"\ciNrHal\c [._1 FIRM. PIZEs FN nog
NAME OF PROJECTS i /�.�4=5Acy
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only -
PROPERTY OWNFIR
CONTRACEOR
API'LICAN I
PROJECT CONTACT
('the individual to receive and respond
to all correspondence concerning this
upplication)
PROJECT FINANCING
If ho? rahlc u S i.000 m morn
/R('Nt 9. _'7.(95)
NAME
,,AILING ADDRF:.S.S
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NAME.
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MAILING ADDRESS (�
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F:XI'IR,\TION DATE
11111#
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MAILING ADDRESS E-MAIL
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M,ILING ADDRESS. ('IT1, STATE, %II' PRONE
I certify under penalh' of perjury that I ant the property owner or authorized agent of the property owner. / certify' than to the best of np knowledge, the information
submitted in support of this permit application is true and correct I certify that I will comply with (all applicable Ci(y of Federal WaY regulations pertaining to the work
authorized br the issuance of a permit 1 understand that the issuance of this permit does not remove the owner's responsibility fas compliance with local, state, or federal laws
regulating construction or environmental lows.
I further agree to hold harmless the CitV of 1'ederal Kin as to an), claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such
claim), which mqy be made by any person, including the undersigned, and filed against the city, bot only where such claim arises out of the reliance of the ci(y, including its
of and employees, upon the accuracy ofthe information supplier/ to the city its a part of this application.
SIGNATURE:
-- --— --- --_DA"Ill: A_L Z�
PRINT NAME:
kJC�
Bulletin #100—February 19.2020 Pace 1 01,2 k:Ulan(louts\Permit application
1'4/ r l of 1 /lr( 11AA RrA1. V4?Nr,
MECHANICAL, PERMIT
Indicate how munr ofeoch n )e r�)ffinmrc to he o 1hishroEect. Do tint include
AIR IIANDLIN(i UNITS
I ANS
GAS PIPE OU 1 LLI S
AIR CONDFIIONER
FIRFI)LACE INSERTS
_ HOODSc�.:i�
BOILERS
FURNACES
HOT WATER TANKS,ra.
COMPRESSORS
GAS LOG SETS
RI?FRIGI{RAT[ON SYS I
DUCTING
GAS PIPING
WOODS] OVES
SStm ivures to remum.
OTHER (Describe)
I'ql 1 /i of l'/ ( 1181m; II'oNh
PLUMBING PERMIT $ Xj' r
Indicaie how numl o each re o lwure to be installed or relocaled as part o this r n cct. Do not include esisnn icture.s to remain.
--- -- ._ i hl__. L i P 1 — - -----. ---
BATHTUBS,,,, r„�ese�„�<<c,����i,�,� �_ LA VS �ii;,,,,i,.,,,�„ TOILETS WATER PIPING
DISHWASHERS RAINWAI ER SYSTEMS URINALS OTHER (Describe)
DRAINS �_ SIIOWI[RS VACUUM BREAKI.RS
DRINKING FOUNTAINS �_ SINKS „i,,,, WA I ER I ILA 1 L RS (i
HOSE BIBBS SUMPS 1� W 1SIIING MAGI IINES 1 OTAL FIX FUR ES
GENERAL INFORMATION
CRI'r Ie.AL AREAS ()� I'RO PE RT \'' \\,\TER PUR\'E1 OR--SE\\F.R I4 R\�P'1�OIt VALUE ()Y) \/S)'/N'/%; IS1 YItOS M:�S14� IS
y;
EXISTING/rRF.V 10 US USE. I.OT SIZE Syunii reel) F.\ISl INC FIRE SrRirvhr.eR SYtiTE M'! PROPOSED FIRE SUPPRESSION sS'ST F. VI?
L 0 i/OQlhfi Z-2-2— �G� `z �r Z �1 Yes No ��r� Yes No
RESIDENTIAL, - NEW OR ADDITION
RL'A DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE FSE
_. _... .......
BASEMENT
FI RS I FLOOR (or :19obile Home)
SECOND FLOOR'
COVEREDf:NTRY
DECK
GARAGE ❑ CARPORT 1-1
OTHER (describe)
Area Totals
rXnrnc.
reorosro
ro r.1i.
*"NEW HOMES ONL Y" x
ESTIMATED SELLING PRICE S # OF BLDROOMS
COMMERCIAL - NEW/ADDITION
-- - --- - - - - - - - _. - - ---------
Area ill Construction #of
AREA DESCRIPTION Square Feet Occupaoc� Group(s) hTle Stories Additional Information
NEW BUILDING
A1)DII ION
COMMERCIAL. - REMODEL./TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occu ane. Cron construction # of
S Fect p' Croup(s) Additional Information
uale FN PC Stories
"TOTAL BUILDING
S
PROJECT. AREA ONLY
Bulletin #100—Februars19. 2020 Page 2 ol'2 k:A1landoutS\Permit Application