22-103759-MF Permit Application 081522CITY OF 40111�111—
•: a I Way
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PERMT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 8Lh Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentez(u�dtyoffederalway.wm
TARGET DATE
SITE ADDRESS I SUITK/UM.T #
a5Zq Z0:S4- L 1-0
FROG, EcT VALUATION Z[7NIHG ASSESSOR'S TA7CIPARCEL #
TYPE OF PERMIT )$UILDI,'@G ❑ PLUMBING ❑ MECHANicAL ❑ DEMOLITION ❑ ENGrNEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
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cI
ATE
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PRoxE
MAILING AD RESS
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CONTRACTOR
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CITY
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WA STATE CONTRACTOR'S LI ENSE w
EXPIRlLTION DATE
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177
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PRIMARY PHONE
NAME
ING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and
nnnR
MAILING Ess
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
NAME
PROJECT FINANCING
When uaLue is $5,000 or m re MAILING ADDRESS, CITY, STATE, ZIP
{RCW 19.27.095)
91
OWNER -FINANCED
PHONE
I certtfy under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best
of ray 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 authorised 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.
Ifwrther 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 supnK
ty as apart of this application.
SIGNATURE: DATE
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fu 1
Bulletin #100 — February 19, 2020 Page l of 2 k-.\HandoutslPeraiit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate haw many 91 each type offigture to be installed or relocated as port of this project. Do not include exist' ?flares to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER [Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODSjcammercefl
BOILERS FURNACES HOT WATER TANKS IG-I
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT
Indicate horn more a each e v Mure to be installed or reloi
BATHTUBS '11 .k) jShm T Comtu) LAVS (liana sinks)
DISHWASHERS RAINWATER SYSTEMS
DRAINS SHOWERS
DRINKING FOUNTAINS SINKS Irjs�mniccvtyi
HOSE BIBBS SUMPS
GENERAL INFORMATION
VALUE OFPLUMBEVG WORK
xs Part of this project. Do not include existing Aixtures to remain..
TOILETS WATER PIPING
URINALS OTHER (Describe)
VACUUM BREAKERS
WATER HEATERS (EAemmi
WASHING MACHINES TOTAL FIXTURES
CRITICAL. AREAS ON PROPERTY? I WATER PURVEYOR SEWER PURVEYOR VALUE OF %7CiSTWI➢ IMPROVEMENTS
EXISTINGIPREVIOUS USE FAT SIZE (in SqugLre Feep EXMTING FIRE SPRIN-ELER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
e Yes n No D Yes u No
RESIDENTIAL - NEw OR ADDITION
AREA DESCRIPTION (in square feet] EXISTING PROPOSED TaTAL FQR OFFICE USE
FIRST FLOOR [or Mobile Flome]
COVERED ENTRY
GARAGE C] CARPI RT%k�
Area Totals
Lr�1►�
EATS Wr, I PROPOSE
Bulletin 4100 —February 19, 2020 Page 2 of 2 k:\HandautslPermit Application