20-101872-Building Permit Application-05-12-2020-V1CITY OF ', � a= PERMIT APPLICATION
Federal Way PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + per itcenteri �iirityoffederalway.com
PERMIT NUMBER
Y
TARGET DATE 6
SITE ADDRESS
' SU%TE/UNYT
@@ PROJECT VALUATION. ZONING ASSESSOR'S TAX%PARCEL#
o ,: _
TYPE OF PERMIT e
UILDING L MBING" ECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION C' F
Detailed description of work to C; t C
be included on this permit only I
NAME
PRIMARY PHONE
PROPERTY OWNER i )'jam
MAILING ADDRE _ L-7
CITY S�T'ATE ZIP
NAME::. �, U
„ PHONE
1
_MAILING:ADDRESS
CONTRACTORE-MAIL.
CITY STATE Eiii
FAX
WA STATE CONTRACTOR'S LICENSE #'
UBI:#
PRIMARY PHONE
APPLICANT MAILING ADDRESS,
.� „,
11 i 'MAIL
CITY ® STATE ZIP 3 ` "°' 0
FAX
NAME i a
PROJECT CONTACT ® PRIMARY PHONE
(The individual to receive and MAILING ADDRESS
respond to all correspondence E-MAIL
concerning this application) CITY
:�[S�TATEE2IP FAX '..
PROJECT FINANCING xAME j
When value is $5, 000 or more We i i ❑ OWNER -FINANCED
(RCW 19.27.095) MAILI G ADDRESS, TY, STATE, ZIP '
PHONE
I certify under penalty of perjury that am the property owner or authorized agent of the property owner. I certify that to the best
al 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.
f
SIGNATURE:
DATEd
PRINT NAME: „
Bulletin # 100 —February 19, 2020 Page] of 2
k:\Handouts\Pernit Application
M MEC MECHANICALPERMIT:
VALUE:OFMECHANICAL WORK
Indicate how man o each type o fixture to be installed or relocated as
AIR HANDLING UNITS
art o this ro'ect. Do not include res to remain.
FANS
AIR'CONDITIONER_ FIREPLACE INSERTS
GAS PIPE OUTLETS OTHER (Describe)
BOILERS i FURNACES
COMPRESSORS
HOODS (Commercial)
i HOT WATER TANKS (cas)
GAS LOG SETS
_ DUCTING I GAS PIPING
REFRIGERATION SYST
WOODSTOVES
PLUMBING BINC :E IT
VALUE OF PLUMBING: WORK:
Indicate how man o each t e o re to be installed or relocated as art o this ro ect. Do not include existing res to re
BATHTUBS (orTnbJshowercombo) remain.
LAVS (Hand Sinks)
DISHWASHERS RAINWATER SYSTEMS
TOILETS WATER PIPING
URINALS
DRAINS SHOWERS
DRINKING FOUNTAINS SINKS
VACUUM BREAKERS OTHER (Describe)
(Kitchen/Utility) WATER HEATERS Electric HOSE BIBBS SUMPS ( )
h WASHING MACHINES
TOTAL FIXTURES
GENERAL IN>F MAT>[N
CRITICAL AREAS ON PROPERTY?
'�
WATER PURVEYOR.
SEWER PURVEYOR.. VALVE OF EXISTING IMPROVEMENTS
Icy .
e
uc U,
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet )
v
EXISTING FIRE SPRINKLER SYSTEM?
Ii Yes ` No
o
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes �—NO
RESIDENTIAL -NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
' BASEMENT
............ ....._:: ......::.
FIRST FLOOR (or Mobile Home)
f160
1 too
...
SECOND FLOOR
rr
......::: ........
COVERED ENTRY
_....:---------- .........
DECK
............
: ...........................................
GARAGE .ff- CARPORT ❑
.........
OTHER (desoribe)
-
........
Area i of L1
EXISTING
PROPO E
TOTAL
_..::. ..._.::.: ..........
*N.EWHOMO$ UNLY'l*
ESTIMATED SELLING PRICE $ -?
# OF BEDROOMS
COMMERCIAL - NEWADDITION
AREA DESCRIPTION
Area in
S uare Feet
Occupancy Group(s)
Construction
# of
NEW $iILDINGCA
Type
Stories
Additional Information
ADDITION
COMMERCIAL - REMODEUTENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Groups)
ons
Ctruction
# of
TOTAL StULDIN e.
Type
Stories
Additional Information
TENANT AREA ONLY
PItO.TECT;AkiA ONLv"
Bulletin #100 —February 19; 2020 Page 2 of 2
k;\Handouts\Permit Application