21-101610 SF-Building Permit Application-04-22-2021-V1PERMIT A
CITY OF �7V
PE IT CENTER + 33325 81h Avenue
Federal Way253-835-2607 + FAX 253-835-26(
PFRMT NuBER _ _
TARGET
)uth +Federal Way, WA 98003-6325
+ permitcenter@cityoffederalway.com
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE PER IT
BUILDING ❑PLUMBING ❑ MECHANICAL ❑ DEMOLITION El ENGINEERING ❑ FIRE PREVENTION
NAME F PROJECT
^` -T
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME ,t") ,
PRIMIARY PHONE
'1 _ . , -
MAAG ADD t
f f
EMAIL �,
CITY'
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ZIP „p8
NAME
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PHONE
ZdAILzNG ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
URI #
APPLICANT
N E g
P PHONE
ING ADDRESS
C .-. WA
IN-
yS�TATE ZIP
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PROJECT CONTACT1
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PHOE '
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IN, .-
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E-MAILE
(The individual to receive and
respond to all correspondence
concerning this application)
TY e-
=7A
FAX>;
PROJECT FINANCING
NAME. 'R
O E-FIN CED
When value is $5,000 or more
(RCW 19.27.095)
KAILING ADDRESS, CITY, STATE,ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
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 Wary 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 Taws.
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 -maybe 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
informationsuppliedto the city as:a part of this application
a
SIGNATURE:_ ter r» DATE (' :
NAME-
Bulletin#100 —February 19, 2020
Page 1 of 2
k:\Handouts\Permit Application;
VA
MECHANICAL PERMIT LUE OF MECHANICAL WORK
Indicate how many of each type offwture to be ' d or relocated as art of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS F GAS PIPE OUTLETS: OTHER (Describe)
AIR CONDITIONER IREPLACE INSERTS HOODS (Commercia )
BOILERS FURNACES HOT WATER TANKS! (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SS ST
DUCTING GAS PIPING _ WOODSTOVES
PLUMBING PERMIT
VALUE OF.PLUMBING WORK
Indicate how many of each type
offixture to be ins ed or relocated as part of this pnct. Do not include existin rxtures to remain.
BATHTUBS (or tr/shower combo)
s nks)
TOILETS
WATER PIPING
DISHWASHERS
�LAHand
TER SYSTEMS URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (K tchen/Ut lity)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EffiSTHNG IMPROVEMENTS
J48A d 0
EXISTING/PREVIOUS USE
m�
LOT SIZE (In Square Feet)
t
EXISTING FIRE SPRINICI&R SYSTEM?
❑ Yes No-
PROPOSED Fam SUPPRESS SYSTEM?
❑ Yes 7 o
COVERED ENTRY
GARAGE 11 CARPORT 0
P 1.INS
ESTIMATED SELLING PRICE # OF BEDROOMS
a
'
A DESCRIPTION
Occupancy Group(s)
I1r I`11!
11
1
AREA DESCRIPTION
Occupancy Group(s)
OR WIN
Additional Information—
k:\HandoutslPermit Application