21-103509-Building Permit Application-08-23-2021-V1CITY OF VAsAVL
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PERMIT NUMBER ..
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
TARGET DATE
SITS ADDRESS
SUITE/UNIT N
PROJECT VALUATION
ZONING
ASSESSOR'S TAB/PARCEL #
$ tfb) S'ur).vL)
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TYPE OF PERMIT
0,BUILDING XPLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DES9CRIPTION
Detailed description of work to
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be included on this permit only
NAME i
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PRDSARY PHONE
PROPERTY OWNER
MAH.INGADDRESS
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CITY i
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STATE
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ZIP
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MAILING ADDRESS �
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E-MAIL
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CONTRACTOR
CITY
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STATE
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ZIP
FAX -
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WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME 1 �N
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MHILIIKi ADDRESS
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APPLICANT
CITY STATE
ZIP
NAME
PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and
MAIT NGADDRESS
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IFMAIL
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respond to all correspondence
CITY
C—e.�et�L -#*Y
tiTATE
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FAX
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concerning this application)
PROJECT FINANCING
NAME
OWNRR FINANCED
When value is $5,000 or more
KAILINO ADDRESS, CITY, STATE, ZIP
PROBE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent Rf the property owner. I certify that to the best
of ray knowledge, the information submitted in support of this permit application is twee and correct. I certify that I will rnmplU 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, raepenses, and attorneys' fees incurred in
the investigation and defense of such clatrr;l, which may be made by any person, Including the undersigned, and flied against the city,
but only where such claim arises out of the reliance of the city, Including its offieers and employees, upon the accuracy 4f the
ir&r oration supplied to the city as apart of this application.
DATE
SIGNATURE: —
PRINT NAME: 412, 1+4V --- tYA �)
Bulleft #100 - February 19, 2020 Page 1 of 2 kAHandoutsTermit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how marW of each type offm,ture to be installed or relocated as j2art 9f this prglea. Do not include exis ' cres to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (com iw)
BOILERS FURNACES HOT WATER TANKS (Da®)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$ av1?O -,
Indicate how many of each yMe o
mture to be installed or relocated as part 2L this project. Do not include existing matures to remain.
BATHTUBS [ar tLb/ShowercomEa)
2- LAVS (H d33n7ca) i
TOILETS
�� WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Deaeribe)
DRAINS
I _ SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitcflen/uullty)
WATER HEATERS imectric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPRRM
WATER PURVEYOR
SR UM PURVEYOR
VALUE OF S.7USTIl1f@ n6PROVEMENTs
IJr�na�
{ Mte- 4Arveri
[ ILe 0,^-tJ2+lJ
RIQSTINO/PREVIOUS USE
:7r"
LOT SIZE jfu square Feet)
EXMINO FIRE SPRINRL£R SYSTEM?
PROPOSED. FIRE SUPPRESSION SYS SK?
'r. t
p Yes X No
❑ Yes X No
t A-ov%A.C_
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION fin square feet) EXISTUM I PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR for Mobile Home)
COVERED ENTRY
1�1CK
GARAGE ❑ CARPORT
Area Totals
I of L,-v 1 9 b I t C1`1
E.VN ro rRornaan mrxr
# OF
Bulletin #100 -February 19, 2020 Page 2 of 2 kAllandoutslPernit Application