21-104812-Permit ApplicationPERMIT APPLICATION
CITY OF VZN�L
PERMIT CENTER + 33325 811 Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
PERMIT NUMBER
TARGET DATE
SITE ADDRESS
SUITEIUNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL tt
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
APPLICANT
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and
MAILING ADDRESS
E-MAIL
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
1 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 to the city as a part of this
application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 — February 19, 2020 Page 1 of 2 k:AHandouts\Permit Application
MECHANICAL PERMIT
Indicate how many of each
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
PLUMBING PERMIT
Indicate how many of each
BATHTUBS (orTw/shower Combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
of fixture to be installed or relocated as
FANS —
FIREPLACE INSERTS —
FURNACES —
GAS LOG SETS —
GAS PIPING —
r of fixture to be installed or relocated as
LAVS (Hand Since)
RAINWATER SYSTEMS —
SHOWERS —
SINKS (Kitchen/Utility)
SUMPS —
VALUE OF MECHANICAL WORK
of this project. Do not include existing fixtures to remain.
GAS PIPE OUTLETS OTHER (Describe)
HOODS( —rciel)
HOT WATER TANKS (Gee)
REFRIGERATION SYST
WOODSTOVES
VALUEOFPLUMSING WORK
of this project. Do not include existing fixtures to remain.
TOILETS WATER PIPING
URINALS OTHER (Describe)
VACUUM BREAKERS
WATER HEATERS (E,acNc)
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
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
T e
Stories
molill NEW BUILDIN
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet Occupancy Group(s)
Construction
Type
# of
Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY