20-104700-SF-Building Permit Application-12-02-2020-V1PERMIT APPLICATION
CrrY OF PERWIT CENTER + 33325 �oh Avenue South + Federal Way, WA 98003-6325
FedemIANay 253-835-2607 + FAX 253�835-2609 + permitcenter 1yoffederalWayxceh
PERMIT NUMBER
TARGET DATE
SITE ADDRESS
SUITE/UNIT
30921 6th Lane SW, Federal
Way, WA 98023
Lot #15
PROJECT VALUATION
ZONING ASSESSOWS TAXIPARCEL #
$ 165,900.00
5 5 5 7 9 0
0 1 5 0
TYPE OF PERMIT
29 BUILDING X) PLUMBING (N MECHANICAL El DF.MOLITION El ENGINEEMNG 0EE PRFVL,',NTION
NAME OF PROJECT
Mirror Lake Highland
Build a sine family Lesidencejust like one built on Lot 10
PROJECT DESCRIPTION
Detailed description oftvork to
be included on this permit only
NAME
PPIKARY PHONE
Mirror Lake Highland LLC
253-709-8747
PROPERTY OWNER
MAILING ADDRESS
30929 37th PL SW
E-MAIL
bill(aDthenexusstudio
CITY Federal Way Up 98023
com
NAME
The Nexus Studio Inc.
PHONE
same
MAILING ADDRESS
E-KAIL
(same as above)
same
CONTRACTOR
CITY I STATE ZIP
FAX
WA STATE CONTRACTOWS LICENSE EXPIRA'nON DATE
NEXUSS1839M6 7 24
/22
NAME
PRIMARY PHONE
The Nexus Studio Inc.
same
APPLICANT
MAILING ADD PESS
(same as above)
E-MAIL
same
CITY STATE ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
Bill McCaffrey
same
MAILING ADDRESS
(same above)
E-MAIL
same
rrhe individual to receive and
respond to all correspondence
as
concerning this application)
CITY STATE rip
FAX
PROJECT FINANCING
NAME
OVnqE:P,-PINMCFD
When value is $5,000 or ozore
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(A',- W I 92 7,0 9 5j
I cert(fy under penalty of perjury that I am the property owner or authorized agent of the property owner. I certqy that to the best
of my knowledge, the information submitted in support of this permit application is true and correct. I cent qy 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.
Iftirther 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 flied against the city,
but only where such claim arises out of the reliance of the ity, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: ff"A /11�-- DATE Z-12 Z 62
PRINT NAME:
Bulletin # 100 — February 19, 2020 Page I of'2 Bf-ktndoutsftnuit ApplicaItioti
MrtCHANICAL PERMIT
MR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTIN(l
PLUMBING PERMIT
indicate how mamy oLeach typi
BATHTUBS (a,T� b/Sh—Gmb.)
DISHWASHERS
DRAINS
DRiNKING FOUNTAINS
2_
ROSE BIBBS
Exture to be installed or rel
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPING
6 I LAVS (Hand Sinksb
RAINWATER SYSTEMS
SHOWERS
SINKS
SUMPS
(,,As Pipr,- ourLl,,,r,,g
HOODS
I JOT WA` ER qo,.)
REFRIGERATION SYST
2s 2ay oLthis 2roect. Do not in
_2_ TOILETS
URJNAI,S,
VACUUM BREAKERS
WATER BEATERS
WASHING MACHINES
.i4000.00
qude e-xistihq_fLxtures to rem ai n.
OTHER (Describe)
VALUE, OF PLUMBING WORK
s5000-00
hide existhg ��s tO= re" _
WATER PIPING
OTHER (Describe)
GENERAL INFORMATION
CRITICAL AREAS Off PROPERTY?
WATER PURVEYOR
SEVMR PURVEYOR
VALUE OF A&f9TTM IMPROVEMENTS
NA
Lakehaven
Lakehaven
NA
$
EMSTING/PRLWOUS USE
LOT SIZE (In Square Feet)
EMSTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Vacant Land
2480
Ei Yes X No
X ri Yes r.1 No
Bulletin 4100- Fcbman, 19, 2020 Page 2 of 2 BllandoutsAlermit Applieation