20-103976_BLDG APPLICATION_10-28-2020_V1PERMIT APPLICATION
C1FY OF As�,
PERMx
❑ENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2807 + FAX 253-835-2609 + permitcenner(;cityoffederaiway.com
PMMUT NIIXMR ^ -
SITE ADDRESS
aj593 �..s
PROJECT VALUA71ON
Soo
TYPE OF p$RII[IT
- 'TARGET DATE
-
ar
3t❑ 5 ace
BONING ASSRaSOIt'S TAXIPARCEL 0
RS-1 .2 - 1✓ 3 -L-
)g I3UILi]IN0 PLUMI11NO X MECIIANICAL ❑ DEMOUrION ❑ ENGINEERING
01 L.LL FEE 5 C
BUITEMNIT ■
❑ FIRE PREVENT[GN
NAME OF PROJECT
PROJECT DESCRIPTION
Dietaged de,-erpt}an of uork to
F be Included on this permit only
PRIMARY PHONE
RAMS
(2-;3)2"i3` Moon
Et:> Hi -I•-
PROPERTY OWNER
MWUNO ADDRE86 f
i T1
E-KAIL
rrof:�et7l-k;LL 6) i'7Sr+1 •Co�'1
zv [ 3 5004+[ M ����
Cr1'e STATE ZIP
+Ae.OrnA WA. 9BA'ag
PHONE
NAME
fl
MAILING ADDRESS
F�MASL
CONTRACTOR
CITY STATE 23P
FAX
WA STATE CONTRACTOR'S LICENSE 11 EXPIRATION DATE
UBI 11
NAME
ti3R«0
PRIMARY PHONE
2(y, 423 4-<,++
APPLICANT
"LING ADDRESS
�F1v*"+f p^� -,
E-N AIL
F Ar�Gra1►->f t*—Stct►� [�
1 [7t2
CITY STATE ZIP
FAX (;Ot-ICAS `
NAME
PRIMARY PHONE
fit' G
PROJECT CONTACT
(The individual to recewe and
MAILING ADDRESS
E-MAIL
respond to all correspondence
STATE ZIP
FAX
CRnceming Otis LEpplira n)
CITY
xAME
� OWNER-FINAPtCED
PROJECT FINANCING
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
IRCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the ir4formatlon submitted In support of this permit application Is true and correct. i certify that I wilt comply with
all applicable Clty of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal taws regulating
construction or environmental laws.
[further agree to hold harmless the City of Federal Way cis to any claim (including costs, expenses, and attorneys' fees incurred In
the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of ON
Information supplied to the city as p ajthls applicntion.
nATF. °S 11(-fin
SIGNATURE:
PRINT NAME:
Bulletin #100 — February 19, 2020 Page I oi' 2 k:lHandoutslPerrtift
MECHANICAL PERMIT
)rtdinate how mAmny of each
AIR HANDLING UNITS
t AIR CANDMONER
t% BOILERS
0 COMPRESSORS
I DUCI7NG
PLUMBING PERMIT
rAXjU V fo be installed or rei
W
FANS
I
FIREPLACE INSERTS
U
FURNACES
d
OAS LOG SETS
t
GAS r1T9NG
fndu�te hay tIsa a ea[ h
o 114rr IO Ve UISEUICe(s L" rc�v
BATHTUFIS m,',,n 9f—P k'nm [
LAVS
��
RAINWATER SYSTEMS
DisHwASHERS
S� DMNS
SHOWERS
b DRINTONG FouNTAINS
STINKS mi,h -li[+[[ho
0
SU MPS
_ HOSE 1318T3S
GENERAL INFORMATION
CrUrrcau ARMS 09 PROPEWM WATER ra VEYOR
r,jej1-s£ (, 1 �7
6'�$TIIP6rmurjx= USE LOT S=11n Sq— Feet)
v�►c A -?'f -sr- 4R 8 21 G
as mrt pf this TI t. Do not m
_r GAS P1PF OUTLETS
_0 MOULDS [cnmm-4.[I
4 HnT WATF..R TANKS In—)
O REFRIGERATION SYST
0 WGOI)STOVES
08
not
VALUE OF MECHANICAL WORK
$ 3(" 30
•Iude ex-fSdu2fKq�s to rein
Q pTf3ER (Describe)
TOITATS
_dt_
n
URINALS
VACUUM BREAKERS
WATER HEA'rERS tFlr�r<I
WASHING MACHINES
VALUE OF PLUMBING WORK
kB 7
etude exist' --[ores to rerr
WATER PIPING
OTHER {Describe}
TOTAL FIXT'URM
StWER vLRVEYxls
OR VAIUt OF aTlNi t1SPROVEesE1M
C i r-y $ n
EXISTINO FIRE OMMKILER SYSIPM? PROPOSED FIRE SUPPRZ8810M SYSTEM?
❑ Yes)( No � Yes X No
RESIDENTIAL - NEW OR ADDITION
PROPOSED
AREA DESCRIPTION (in square feet)
EXISTrNG
BASER[ENT
S a
FIRST FLOOR (or Mobile Horne)
2-432
�o
SECOND FLOOR
CC)VERED ENTRY
�Z
DECK
GARAGE f CARPORT ❑
lO$S
OTHER (describe)
EICl STING PRGpoelm
Area Totals "57-1
**NEW HOMES ONLY"*
TOTAL
TOTAL
Co 3 2-'1
ESTIMATED SELLING PRICE $ r0� , VC?Q I " t)f' BEDROOMS _.
COMMERCIAL -- NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s)
$ uare Feet
NAWBunam
AnDmoN
COMMERCIAL - REM 0DELITENANT I MPROV EMENTS
AREA DESCRIPTION Area in Occupancy Grouplal
Square Feet
TOTAL B=DING
TEmANT ARLA ONLY
PROJECT AREA 01MY
FOR OFFICE USE
..........
Construction I M of I Additional Information
construction ` # of y Additional Information
Tune 1 Stories I
Bulledn #100 -- February 19, 2020 Page 2 of 2 k:\HundoutS\Ptrmit Applicatio