22-102487 - CO Permit Application Office T.I. - Edward Jones - Falcon Building (Suite 160)PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permiteenteECcvLeilyoffederalwU.com
TARGET DATE
SITE ADDRESS
SUITENNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
El BUILDING El PLUMBING El MECHANICAL El DEMOLITION El ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit onitj
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
El OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW19.27095)
I certify under penalty ofperjury 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 Pederal 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.
Ifurther agree to hold harmless the City ofFederal 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.
SIGNATURE: Christian LaRocco DATE
PRINT NAME:
Bulletin #100 — January 29, 2016 Page I of 2 k:\Handouts\Pen-nit Application
MECHANICAL PERMIT � $
Indicate how many of each type Qffixture to be installed or relocated as part of this pr*ct. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (Ga.)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
19RULN-IRNM
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/Sho— Combo)
LAVS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Ei Yes Ei No
Ei Yes Ei No
COMMERCIAL — NEw/ADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
Type
Stories
NEw Emma
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
I
Occupancy Group(s)
Construction
# of
Additional Information
I
Square Feet
TvPe
Stories
TENANT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Pen-nit Application