12-102639ti
RECEIVED - C°�^�g
CITY OF PERMIT SFMF CO ME PI. DE•,�{EN�lFP
Federal Way J U N 11 2 1 �s
COMMUNITY DEVELOPMENT SERVICES P LI C AT I O N
253935.2tip7•FrLC257•N.'!5.3609 OF FEL)ERA L WAY
es,
CDs
SITE ADDRESS /` SUITE/UNIT #
L.4KG
Z I `�f}ve Si,1�- Sw'33W{''6�i� SlE1 337'"st� tr•U a36;^Sf-/ 9'i��e Sim �l-o ^� Z�S�
PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL #
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION 9 ENGINEERING El FIRE PREVENTION
NAME OF PROJECT y {'
(Tenant Name/Homeowner Last Name) .Z S T,, ye, $ lti Jw-� S W i 3 �J 5��(G J � e-cam'" 0 -y `""`,P 11 `' ,1--'"'
- LfiAreM t,5 'Tl7 fr+e!Jazt,E, [ci f ' pf 1,tiFusee+lowly 1r�r�+i.* SW s'7 'I� /• I [..:A v
PROJECT DESCRIPTION p
Detailed description of work to :.nC s)' 60Ad 4wA;f�r c %•c� ���9tQ- It �41V 6"9 5I4a36 k.:t+ na
be included on this permit only
:.,,'j•Iee--t 1!c z 1, Ji L. eY'/ ,.: c•�. zl ,i1r�cPrt ,� ..
NAME PRIMARY PHONE
PROPERTY OWNER j t df Fe'-d e rec l GVtt Z "-?- O �- 2 7 Z
MAILING ADDRESS E-B AIL crt i
7J7 3 Z S O' 7h Y-G- �• yv4+n , •M1J�iC2. ,'� a�/'Y2,6 eL'ri .r
CITY J STATE ZIP
bj� w/4 I 9 gig 0
NAME
PHONE
MAULING ADDRESS
E-MAH'
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
.-3oL,, A4,�L,
PHONE
253-83s-Z7LZ
MAILING ADDRESS
333LS8����GS
E-MAILAPPLICANT
`,:1,,,.,K„E�
CITY
FP I�t ,-- k �-• Ll
STATE
(I' 4-
ZIP
99003
FAX
G$ 3- 94Y- Z709
PROJECT CONTACT
NAME
3ok,^ v Ike
PHONE
ZS3-E'3s z7u
(The individual to receive and
F-MAIL
respond to all correspondence
MAH.ING ADDRESS
33325- ?;-Ave
concerning this application)
CITY
1e114.L Wa
STATE
/r'/4
ZIP
9Bdo3
FAX
zS - 3s _i7oy
TERNATE CONTACT+ NAME:
PHONE
F MAD.
:L.rk,/ r
PROJECT FINANCING
NAAM
a �ci /�A�� S iG KIP
�� c,• -m ,�p�f�
Jk OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
I 7 rit
MAILING ADDRE,SiS, CITY. STATE, ZIP
PHONE
333z�+'IFIrr_ 5
�$ r✓ V3S--Z�2Z
J
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I eert(rg that to the Nest
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 Mork 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 casts, expenses, and attorneys' fees incurred in
the investigation and defense ofsuch claim), which may be made by any person. including the undersigned. andfiled 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 ci as a of this application.
SIGNATURE: DATEf ��
PRINT NAME: �ti ✓ I
3ulletin #100 - January 1, 2011 Page 1 of 3 1c: uzdlluUuu r c11,u, YF.,-11
`
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $
(a copy n bid or estimate must be rouided)
Indicate how marry of each type of fixture to be installed or relocated as part 9f this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
r AIR CONDITIONER
FIREPLACE INSERTS HOODS (commercial)
BOILERS
FURNACES HOT WATER TANKS (Gas(
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
r DUCTING
GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how IRmty of each type offLrture to be installed or relocated as part of this profecL Do not include existing fixtures to remain.
BATHTUBS (or Tab/Sho combo)
LAVS (Hand sinks) TOILETS WATER PIPING
_
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (ttitchcn/UWity) WATER HEATERS (Elea tc)
HOSE BIBBS
SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?�WATER
PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
/lip
�r��,l;�y D�r.cr
AIIIt
$ 2
E � /P E$VIO f S USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes 5eNo
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes W No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
EXISTING 111WN]PY.i! TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
Area � Construction # of Additional Information
AREA DESCRIPTION in Square Feet Occupancy Group(s) Stories
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet a Stories
TOTAL BUILDING
TENANT AREA ONLY
PRO.IECT AREA ONLY,
Bulletin #100 —January 1, 2011 Page 2 of 3 Uflandouts\Permit Application
FOR OFFICE USE