20-104048-Building Permit Application-11-13-2020-V1A111kkhI`
CITY OF PERMIT APPLI C I
Federal WayPE T CENTER + 33325 8� Avenue South + Federal' Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + pen iteentevii,cityo#"federalivay.coni
PERMIT NUMBER
�— TARGET HATE
SITE ADORES& SUITE/UNITI `, t
4Z,
0
PRO.=T VALUATION ZONING ASSESSOft's TAX/ _ A iCEL #
TYPE OF PERMIT
BUILDING El PLUMBING MECHANICAL El DEMOLITION ❑ EVC,INEE
PING El FIRE PREVENTION
NAME OF PROJECT
r4 � .-` ' ,C 1 ;
PROJECT DESCRIPTION
� {
Detailed descriIation of work to
be included on this permit only
NAME PRIMARY PHONE
� s
PROPERTY OWNER
NG ADDRESS
CI ySTATE ZIP x
NAME ".
PHONE
MAIL RE
I� MAIL
CONTRACTOR
dy a ' Gar,
C STA�T+,,E 'SIP
)rZIOVA
FAX
STATE CONTRACTOR'S LICENSE ak. EXPIRATION HATE
UEI # F
1
NAME g
Ili
PRIMARY PHONE _
t
APPLICANT
MAIL[ G I� SS a
F, MAIL
°47 4 Ih
GI STATE ZIP
FAX
PROJECT CONTACT
NAME_i
PRIMARY PHONE
(The individual to receive and
MAILING ADDRESS
E-MAM
respond to all correspondence
concerning tl as application)
CITY STATE ZIP
FAX
PROJECT FINANCING
iIAmE
Whenvalue is $'$, (IQG' or more
IRCW 19.27,095)
OWNER -FINANCED
MAILING ADDRESS, CITY, STATE. ZIP
PHONE
I cer"fy under penalty of perjury that T am the property owner or authorized agent Of the Property
of my knowledge, the information submitted in Support of this permit application istrue
and correct. .1 certft thaxtiI 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 the permit ;does not remove the
OWner'S responsibility for compliance with local, state, or federal taws 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 including
person, 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 suppli to the city as apart of this placation.
SIGNATURE: idAIE
_PRINT NAME: �---
Bulletin ##100--February 19, 2020 Paige 1 of'2
k;iHandoutsTerrilit Application
MECHANICAL PERMIT VALUE OF MBCHANICAL WORK
Indicate hoT man fixture to be installed or relocated i;!iiii part of this proiecL Do not include III I', fixtures to remain.
AIR HANDLING UNITS — FANS GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
— FIREPLACE INSERTS HOODS
BOILERS FURNACES
COMPRESSORS HOT WATER TANKS
GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT
VALUE OF PLUMBING WORK
I
Indicate hole naaxx a each t e o
—
zxture to be installed ar retcafed as art o this rpiect. Do not include exists ix ores to remain.
BATHTUBS (or rub/Show-Cornb.)
DISHWASHERS
DRAINS
— LAYS (Hand s.ksj TOILETS WATER PIPING
RAINWATER SYSTEMS URINALS
— SHOWERS VACUUM BREAKERS OTHER (Describe)
DRINKING FOUNTAINS
HOSE BIBBS
— SINKS (Kitehenjutiiityj
SUMPS
WATER HEATERS (Elect ,j
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS Q1W PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF 4VAT—MIMPROVEMENTS
FXIS TING/PR&VIOUS USE
LOT SIZE (In Square Feet)
STING FIRE SPRIZIEL.ISYSTEM?
E: Yes i-, No
:i Yes i-i No
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