22-100865-Permit Application-3-1-2022-V1FCITY OF PERMIT APPLICATION
ederal Way PERMIT CENTER + 33325 80h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentereacityoffederalway.com
PERMiT NUMBaR
— "— -- TARGET DATE
SITE ADDRESS
10 L 4 �a..-!.¢. 2A ,�W/i.✓t} 8`00 SUITE/UNIT •
PROJECT VALUATION ZONING
ASS �� ��� • � ESSOR'S TAR/PARCEL M
C �- F` v 4-
TYPE OF PERMIT—
. UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT J
11 %
PROJECT DESCRIPTION 1 f�•�..w...�._ i.o v ��-+.� PGA
Detailed description of work to
be included on this permit only nn
Ti- air.,
PROPERTY OWNER
N
K� t j- Q _ / �+
"W (.7
V+t. w.e...�-.,.
PRIMARY PH
MAILDi tADREBa'.
3 2"k
J .lam +a..;�`" F
SPATE ZIP
0.7
Wl� (Poo
„ l g
NAME _
MAX
CONTRACTOR
-W ADDRESS
, �Ooc
R-MAM
•�
C?O2Z
STATE ZIP
WA 0 071
WA STATE
FAX
CONTRACTOR'S LICENSE N
U cc. "C. O !4 /r t EXPIRATION D�AT�
N E »
�e 9.,
�! _ 4�
'�.
J E -
S4
RDdARY P
2'T3 2%
APPLICANT
INGADDR
-
olTx
�� L STAT& ZIP
hr� 1 —I IS c-
c•�.rc.��- 7
NAME w� y r1'v�3
FAX
PROJECT CONTACT
IC-Cr` w r,(,e J
PRIMARY PHONE
(The individual to receive and
1tAILINO ADDRESS T
respond to all correspondence
concerning
J tom( i � IL -
&KAIL
this application)
crrY 1�-a
STATE ZIP
FAX
PROJECT FINANCING
NAME
When value 19.27.n951 0or more
'r / A
MAILING
OWNER-FINANCED
f�'w t.27.
ADDREss, CITY, STATE,
PHONE
I certify under penalty ofP¢rJury that I am the property owner or authorised agent of the Property owner. I
41' o+y knowledgs, he i'VOrM ion submitted in support of this permit application is true and correct. Ice Cerft that to the best
all applicable Cityo ay regulations r ft that I will co
Issuance of this permit does not remove the owned sega work autl�ri;ed by the issuance of a understand
comply with
construction or environmental laws. responsibility f mpltance udth local, state, federal ratanaws regulating
the
the investigation agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys'
gation and dUense of such claim/, which m rrteys' fees Incurred in
but only where such claim arises out of the reliance of any parson irtciuding the undersigned, and led
i/4%r'mation supplied to the c{ ty, the its officers and a to a against the city.
city part of this application. mp yes, upon the accuracy of the
SIGNATURE.- -'-'
. n DATE Z Z Z
PRINT RAME: _10eiJ� 'r t1DC1�Ff �r i t' e- r .A -r
Bulletin # I OQ - February 19. 2020
Page I oP2 k:\HandoutslPermit Application
MECHANIM, PERMIT
VALUE OF MECHANICAL WORK
Indicate how many o e type offixture
to be installed or relocated as
part of this project. Do
clude existing fixtures to remain
AIR HANDLING UNITS
FANS
GAS PIPE
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HO ( 'ommemial)
BOILERS
FURNAIC
WATER TANKS (Gaa)
COMPRESSORS
SLOG SETS
��01
RATION SYST
DUCTING
GA ING
TOVES
PLUMBING PERMIT
VALUE OF PLUMBING WORK
$
Indicate how many ofach t re to be i ed or relocated as p,rt o ro'ect. Do not include exdstingfixtures to remain.
BATHTUBS (or Tub/Sho ombo) LAVS (Hand Sinks( TOIL WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
D NG FOUNTAINS SINKS (Kitchen/utuity) WATER HEATERS (electric)
OSE BIBBS SUMPS WASHING MACHINES TAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
K/A
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
fe ��AICf�7-1A
LOT SIZE (In Square Feet)
SIt CJ- 3 �'
EXISTING FIRE SPRINKLER SYSTEM?
71 Yes XNo
PROPOSED FIRE SUPPRESSION SYSTEM?
Yes KNO
RE ENTIAL - NEW OR ADDITION
AREA CRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile�Ho.
SECOND FLOOR
_.......
..---........... ......__..............._....._...............---..__._.................... _..............
COVERED ENTRY
DECK
GARAGE 11 CARPORT ❑
....... _....... ................. ........_.._................_........_.._........._....__..__......................
OTHER (describe)
............. ............. ....... ._......
......
............. _................... ......._.....__......----........ .._............ ...................... __.........
Area Totals
EXISTING
PROPOSED
TOTAL
........................_
... _..._....._..------........ ....... _..... .................................. .... .............. _.... ............. _
**NEW HOMES ONLY**
E ATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDEW
TENANT AREA ONLY
yL f�` ��
G 7s -e-
I
PROJECT AREA ONLY
1zy�
Bulletin # 100 —February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application