21-102234-CO-CONSTRUCTION APPLICATION-6-4-21-V1CITY Of PERMIT APPLICATION
a �
PERMIT NUMBER
.�._. �
'I"AlttrET DATE
SITE ADDRESS
_
_.. _...
SUITE/UNIT11
PROJECT VALUATION
ZONING ASSESSOR'S TAX/PARCEL #
56, 0
Af 2` If
f .tip: ....
�y
� 0
TYPE OF PERMIT
BUILDING ❑ PI m mG ❑ MECHANICAL Q DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
-Oco RELLPROJECT
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0 Q 1 V "( '' Jj`J':r+ k/ I _,V 0 .0 A-,O
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DESCRIPTION
Detailed description of u)ork to
WAI a4li7.
be included on this permit only
NAME
PRIMARY PHONE
' wR— 9— At,r I—t..c-
2 01 .7 ?
PROPERTY OWNER
MAILINGADDRESS
E-MAIL
CITY STATE
ZIP
1WIA
7e079—
NAME
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A //VV
PHONE
rw • `79. e ra t`
MAILING ADDRESS
E-MAIL 6b ros 4 ✓'7
CONTRACTOR
1/o //0 q
...:ZIP
he-m rl o.'A A w . a
CITY. STATE
IWI5tad , A
1?9j�
"/
FAX
WA STATE CONTRACTOR'S LICENSE #
d41<4 7/fri1 Z90 1`3
EXPIRATION DATE
/
UHI
/91 �r
NAME _
}1
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
710 /0q 7P , 6 r 6
FWAIL b 1-d51li Q,1
CITY 'STATE
ZIP
tAX.
PROJECT CONTACT
NAME _. _. `..
IAA) Z vA)l'
PRIMARY PRONE
VI�t
(The individual to receive and
MAILING ADDRESS
wo i6q s7 c7_ 5 -
E-MAIL
respond to all correspondence
.
concerning this application)
CITY STATE
4AKWO00 WA
ZIP
91
FAX
PROJECT FINANCING
..NAME. _..
El OWNER -FINANCED
When value is $S, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27,095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify thattothe 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 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, 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.
Bulletin #100 Fcbruary 19, 2020 Page 1 of l :TIandoutsTermit Application
VALUE Or MECHANICAL WORK
Indicate how many of each type offibdure to be installed Or relocated as art a this ro'ect. l7o yztat include existin ixtalres to remain:
AIR HANDLING KNITS FA 8 GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS IIOODS (Gaaaner w)
BOILERS FURNACES HOT WATER TANKS (G-1
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
LALUE OFPLUMBING WORK
PLUMBING IN I RMIT
Indicate how man of each type of i-tare to be installed or relocated as part of this project. Do not include ex stirs cvtures to remain.
BATHTUBS (nrT.b/Showers.-" LAVS (Hand Si ks) TOILETS. WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitchen/Ue uey) WATER HEATERS (Fi—L i�(
HOSE 131BBS SUMPS WASHING MACHINES TOTAL FIXTURES
Ii, NERAL INFORMATION
CRITICAL AREAS ON PROPERTY?' WATER PURVEYOR. SEWER PURVEYOR.. VALUE OF EXISTING IMPROVEMENTS
BXISTING/PREVIOUS USE ..... LOT SIZE: (In Square Feel) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED IF°IRE SUPPRESSION SYSTEM?
Yes o Na i Yes Ei No
el
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\1=landouts\Permit Application