22-101466-Permit Application-4-13-2022CITY OF"
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
Q _L ± L 6 0 TARGET DATE
SITE ADDRESS
SUITE/UNIT #
/&I11) 5 3�
a
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
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NAME err
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PRIMARY PHONE
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PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
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CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
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NAME
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PRIMARY PHONE
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MAILING ADDRESS
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E-MAIL
APPLICANT
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STATE y�
ZIPPP
FAX e
NAME
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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
(RCW 19.27.095)
MAILING ADDR SS, CI , 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 to the city as a part of this application.
SIGNATURE: DATE
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PRINT NAME: C7
0
Bulletin #100 —February 19, 2020 Page 1 of 2 k:\J-IandoutsTermit Application
VA
MECHANICAL PERMIT LUE OF MECHANICAL WORK
Indicate how many of each tzjpe offixture to be installed or e as art of this project. Do not include existing lxtures to remain.
AIR HANDLING UNITS FAN GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER REPLACE INSERTS HOODS (commercial)
BOILERS FIFURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTI GAS PIPING WOODSTOVES
VA LUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how many of each type offixture
to be installed or reIQ
part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/ shaWerCombo)
LAVSera inns)
TOILETS
WATER PIPING
DISHWASHERS
INWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING F S
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/RREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIkE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
-Yes ❑ No
❑ Yes y No
RESIDENTIAL - NEW OR ADDITION
AREA CRIPTION (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 ERISTING 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
AD ION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Square Feet in
Occupancy Group(s)
Construction TypeStories
Additional Information
TOTAL BUILDING
/_ A f 5-5—
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16
V 5
TENANT AREA ONLY
l `7 -
PROJECT AREA ONLY
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Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Pernut Application