22-103019 BENJAMIN DECK - APPLICATION 22-07-05PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter( cityoffederalway,com
PERMIT NUMBER
SITE ADDRESS
SUITE/ UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ le,9000
V)
-- F 0
0 / 0 q Z_ C) 0
TYPE OF PERMIT
fJ BUILDING El PLUMBING El MECHANICAL 11 DEMOLITION El ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
13-ea
PROJECT DESCRIPTION
Detailed description of work to
-i
be included on this permit only
NAME
PRIMARY PHONE
-, �CW
�iA
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
_339-,mi
CITY
STATE
ZIP
?8-0,�3
1 1
NAME tlC
son '-,
PHONE
MAILING ADDRESS
f 7 S R n e, cw It,
E-MAIL
0 193� r
CONTRACTOR
-7,?,
CITY STATE
ZIP
FAX
r
�ya C1
yyp
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
9�
U.I #
'IT
7/
7W a,?-
It /
NAME
PRIMARY PHONE
MAILING ADDRESS
1W SO
E-MAIL
APPLICANT
CITY'
STATE
ZIP
FAX
L",Cfj
NAME—
PRIMARY PHONE
PROJECT CONTACT
MAILIdG hDDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
ZIP %I—
FAX
concerning this application)
PROJECT FINANCING
NAME
A
OWNER-FINANCED
When ualue is $5,000 or more
—LING A(DDRESS, 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 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.
[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 tot city as a part o this application.
SIGNATURE: DATE
PRINT NAME:
a
Bulletin #100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECIIANI PERMIT $
Indicate how many of each type o72pqwr installed or relocated as Is ro'ect Do not include exist&zgfixtures to remain.
AIR HANDLING UNITS FANS 12, GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLA ERTS HOOD (co
BOILERS ACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate of each type offixture
to be installed or relocated as
ro ect. Do not include existin. Lxtures to remain.
BATHTUBS for fhb/shower Como
LAVS Hand s n)
TOILETS
WATER PIPING
DISHWASHERS
I La,SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VAC {ERS
DRINKING FOU
SINKS (xitchmfutility)
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 Squaze Feet) EXISTING I = SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
�S+tot tl�ei
COMMERCIAL — NEWADDITION
a in Construction # of
AREA DESCRIPTION Square Fee Occupancy Group(s) Tune Stories Additional Information
Bulletin #100 —February 19, 2020 Page 2 of 2 k:\Handouts\Pemiit Application