22-100688-Permit Application-5-26-22PERMIT APPLICATION
CITY OF 0;tkk
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + pennitcenterCacityoffederalway.com
PERMIT NUMBER f 12 - TARGET BATE 0-7/n/Mv—
SITE ADDRESS
WAY, VA
SUITE/UNIT It
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
12 "fitxv
V'J°�1,�b/�o-1
L 5- L -
A 0
TYPE OF PERMIT
[A/BUILDING El PLUMBING El MECHANICAL El DEMOLITION I--] ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
(_AAA 90,� IeM �301IioA
TW_
112 aWdeA&fm
PROJECT DESCRIPTION
Detailed description of work to
be- ytr4o&, WA! AM 0� 0A.4A
AVV4
WerAlkj
i�2 tl CA 4011
be included on this permit only
NAME
Ae, � �-�A 1 t A
PRIMARY PHONE
M_
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
qv- (V,4mi
Av,
CITY
STATE
I WA
ZIP 44a
NAME
OA4",4t,60
PHONE
lob �0,7 - lv
MAILING ADDRESS
1-79V 0R &, /;Q -Tt-?Aq
E-MAIL
1464iO'AA44V. &AM
CONTRACTOR
CITY
V"A4J4 0*r
STATIK
WA
ZIP
ftLk�
PAX
WA STATE CONTRACTOR'S LICENSE W
6e-sAmegmG
EXPIRATION DATE
07-
UBI
U,,A
NAME �--*
c�
PRIMARY PHONE
MAILING ADDRESS
o Ltli`N Aw, � U /40- 0"
E-MAIL
417 fAQ eAdAA;YV_rW.A*apt
APPLICANT
CITY
S�`ATE
T
�q
Ax I I
PROJECT CONTACT
NAME
Ajl;�a,
PRIMARY PHONE
-n�
IL
M AZ ING ADDRESS
A.4, W
E-MAIL
a
(The individual to receive and
respond to all correspondence
CITY
CJLM�
STAE
k
ZIP
1
PAX
concerning this application)
PROJECT FINANCING
NAME
43/ OWNER -FINANCED
When value is $5,000 or more
(RCW19.2ZO95)
MAILING 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 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 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.
SIGNATURE:
DATE
PRINT NAME: —
Bulletin #100 —February 19, 2020 Page I of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each ttlp
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
PLUMBING PERMIT
Indicate how many of each typ
BATHTUBS (., T b/Sh.,cr Combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
to be installed or relocated as
FANS _
FIREPLACE INSERTS _
FURNACES
GAS LOG SETS
GAS PIPING
to be installed or relocated as
LAVS (Hand Sinks) _
RAINWATER SYSTEMS _
SHOWERS —
SINKS (Kitchen/Utility) _
SUMPS
f this project. Do not include
GAS PIPE OUTLETS _
HOODS (Commercial)
HOT WATER TANKS (Gas)
REFRIGERATION SYST
WOODSTOVES
TOILETS
URINALS
VACUUM BREAKERS
WATER HEATERS (Electric)
WASHING MACHINES
g fixtures to remain.
OTHER (Describe)
VALUE OF PLUMBING WORK
WATER PIPING
OTHER (Describe)
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?
❑ Yes ❑ No
❑ Yes ❑ No
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin # 100 — February 19, 2020 Page 2 of 2 kAHandouts\Permit Application