21-102564-Building Permit Application-6-23-2021-V1CITY OF
Federal
ftmoT i umBE
Way
PERMIT APPLICATION
PERMIT CENTER ♦ 33325 81h Avenue South +Federal Way, WA 98003-6325
253-835-2607 +FAX 253-835-2609 + permiteenter@c;ityoffederalwa3t.conl
'ARM DATE
SITE ADDRESS
$UI'1'EJUNTT #
/V/L� S(NZ4 37-qvAl
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$
c,C,F
t
-L
TYPE OF PERMIT
i`PBUILDING ❑ PLUMBING D MECHANICAL El DEMQLIT[QN 1:1 ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
k(: C � �`� 5 ` f � �' rrrt S ' ., i•�� � `�C' � �/' G�-� �r�.� Lt�E. � f L � ��n � � F
PROJECT DESCRIPTI4N
Detailed description of work to
S �L
be included on this permit only
xaIMM �
�i� l i't� SE'Ly.�.OL (� i�-7� . � � r `t�� l) d �r` c �. ��
�MARY PHONE
, . ,
L�
� 92
PROPERTY OWNER
MAILING ADDRESS
� it1 SGt-� l� vl. �i , �i b �
&MAIL
h n G h � C
CITY / STATE ZIP r,
ij
NAME �
PHONE
iurArLING ADDRESS
E-MAII, �
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE
UBI #
4V
NAME --
aAmu, 4( ; -V) e
PRIMARY PHONE
MMLING ADDREM
E-MAiu,
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
MAILING ADDRESS
� `�� �i' � � � � (� 1 0 D
E-MAIL
(The individual to receive and
respondto all correspondence
concerning this application)
Cx'z`Y
STATE
Zip
cl,
FAx
�-C, 05
PROJECT FINANCING
NEE
OWNER -FINANCED
When value is $5,000 or more
MAiLIl+IG ADDRESS, CITY, STATE, ZIP
PHONE
(RC4TT 19.27. E195)
I certify under penalty of peijury that I are the propel owner or authorized orized agent of the property owner. I rt(& that to the Est
of my knowledge, the info ation submitted in support of this permit application is true and cor~rct. I certify that I r-i l. comely with
all applicable City of Federal Wag regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance , f this permit dues not remove theowner's responsibility for compliance with local, state, or federal laregulating
construction or environmental laws.
I further- agree to hold harnnless the City of Federal Way as to any claim i including costs expenses, and a arneys' fees incurred in
.e investigation and defense of suchclainq, which may be made by aity person, including the undersigned, and ,flied against the city,
but only inhere such claim arises out of the reliance of the city, irwluding its officers icers and employees, upon the accuracy of the
information supplied o the city as a part of this application.
�c
SIGNATURE.
PRINT NISI.
. �.
DATE
b PK
- (61111�
Bulletin :#1 00 — February 19,2020 Page 1 of 2 k:\Handouts\Pennit Application
MECHANICAL PERMIT VALUE OF MECHANICAL WORK
Indicate e oLflxture to be kstalled or relocated art 2L the prqjecL Do not include xisLz. xtus to remain. -
AIR HAIL UNITS FANS
- - GAS PIPE OUTLETS OTHER Describe
AIR CONDITIONER FIREPLACE INSERTS HOOTS (Commercial)
- ---- BOILERSFURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING TINO GAS PIPING WOODSTOVES
PLUMBING PERNUT VALUE OF PL UM13HVG WORK
$ ;� 0 b�
Indicate how mapA of each Ylpe 9L LLxture to be installed or relocated as part of the prQLect. Do not include existirig. ures to remain.
BATHTUBS [or Tub f owerCombo) LAVS (Band inks) TOILETS WATER PIPING
.DISHWASHERS RAINWATE, R SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING KING O NTAINS SINKS (Kitchen /U ditty) WATER HEATERS (Electric)
HOSE I S SUMPS WASHING MACHINES TOTAL FIXTUR.ES
GENERAL
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEVMR PURVEYOR VALUE OF EMT= IMPROVEMENTS
OJIA�,
XI "TINT PREVIOUS USE LOT SIZE JIa Square Feet) EXISTING SPRINKLER 91� PROPOSED SUPPRESSION SYSTEM?
o Yes ❑ No
Yes El No
ERiESIDENTIA-L
AR
CRIPTION (in square feet) EXISTING PROPOSES TOTAL CE USE
' .....+..:i.i�i............**..7l41♦.nii..........r......................................*rt.r..rr...............*
BASEMENT
FIRST FLOOR. r Mobile Home
.............................................................................................................................
SECOND FLOOR
i.rrtrt.r�,.s...........F...+.r..FrF....i..i..■►..................................i..i.+...............t.r..
COVERED ENTRY
..............................+.i...ii.,...................................Y..r......fi....+.*.i..#.++... .. ..................
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
EM......r.**.�+.as..a,t.+.��.................,,.+++..............................i..ii.,.6......■.........+.+.i.w......,.......
Area Totals MSITG PROPOSED TOTAL
WE W HOMES OAMY
ES
TIMT SELLING PRICE $------ tF F BEDROOMS
COMMERCIAL - NEW/ADDTTIQN �
AREA DESCRIPTION Area in Construction # of
u --- _ 5 are Feet Occupancy Group(s) e Stories Additional Information
NEW BUILDING `. `"------ �-
ADDITIQN
r
COMMERCIAL - REmoDEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction s o es Additional Information
Square Feet
TOTAL BCTILDING 2
TENANT AREA ONLY Z)
PROJECT AREA ONLYP.� 14
Bulletin #100 —February 19, 2020 Page 2 of 2 k:\Handouts\Pennit Application