21-102009-Building Permit ApplicationCITY OF 4k
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81b Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentercdcityoffederalway.com
TARGET DATE
SITE ADDRESS SUITE/UMT •
3g8n to Q023
'Ind
PROJECT VALUATION
ZONING ASSESSOR'S TAR/PARCEL •
$ r.J - i1
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
O&
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS U
6 50 34
E.etAD
2-'fS! � 1
CrrY
STATE
ZIP
8 2- 3
NAIL r! r jrxk n-
PH)-53 - 3 79 - 2-6-0-7G�-7
11 SC r 7 v,,/ ,
it -MAIL
CONTRACTOR
CITY STA
ZIP
FAX
G1L(3YLC/.`
q c
1:�,VATE CONTRACTOR'S LICENSE i
v
EXPIRATION DATE
**o* •
603Ss7
PRd&AHY P—v,.s
20-3(43-CCRS
NAME
'
APPLICANT
MADJNO ADDRESS
E-NAM,
CITY
eg'Aa�
ZIP
NAME
PRIMARY PHONE
PROJECT CONTACT
I
MAD.Dio ADDRESS
E-MAIL
(7he individual to receive and
respond to all correspondence
CrrY
STATE
ZIP
FAR
OWNER FINANCED
concerning this application)
PROJECT FINANCING
NAME❑
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I cart(* under penalty of pedury that I am the property owner or authorised agent of the property owner. Z cerft that to the best
of my knowledge, the btformation submitted in support of this permit application is true and correct. Z eerft that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. Z 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 gf'such claim,►, which may be made by any person, including the undersigned, and flied against the city,
the reliance of the city, including its officers and employees, upon the accuracy of the
but only where such cl arises;apart
ir4formation supplied city o th ication.
L
SIGNATURE: DATE IlI y�
PRINT NAME: i �^
Bulletin #100 — February 19, 2020 Page 1 of 2 k:lHandoutslPermit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated as vart of this Project. Do not include e;dstbig f4fures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercw)
BOILERS FURNACES HOT WATER TANKS paws)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how man of each type o
fixture to be installed or relocated as part of this project. Do not include existingfwwes to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Hand mn1w)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/ut[7iq)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FECrURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER
PURVEYOR
SEWER PURVEYOR
VALUE OF Z=T= IMPROVEMENTS
�:Ju
$
EXISTING/FREVIOUS USE
LOT SIZE (In square Feet)
EBISTDiG FIRE SPRDHILER 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
gliZ
GARAGE ❑ CARPORT ❑
OTHER (describe)
.........................................................................................................................
Area Totals
`XH=O
.........................................................................................................................
"AFEW HOIlfES 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 I — I I I I
COMMERCLAL - REMODEL/TENANT IMPROVEMENTS _
AREA DESCRIPTION Area is Occupancy Group(s) Construction # of Additional Information
Square Feet a Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application