22-102772-SF Permit Application-7-28-2022-4w
CITE OF
-weep,
PERMIT 17tM EP.
0
pr I O N
JL JLWm& .a i + i+, + +� i � — —
PE� RMIT CENTER + 33325 8Avenue South + Federal WaY, WA 98o03..6325
253-835-2607 + FAX 253-835-2609 + permitcenteV(4CitY0-'rr,
T Ir
a Ppr.TCA
TARGET DATE
02 15 /Oa4)42 02
SITE ADDRESS SUITE/L11vIT #
4 729 SA) 3 /3 Pl cl Ce �-e derao
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL M
$ l000 ��� �'70-
TYPE OF PERMIT lbl BUILDING ❑PLUMBING ❑MECHANICAL 1:1DEMOLITION ❑ENGINEERING ❑FIRE PREVENTION iiiiiiiilllllllllllllIIIIIIIIIIIIIIIIIIIIII..-----PI
NAME Off' PROJECT rs
PROJECT DESCRIPTION S+04' r � n � ex C1 � � r 0 � N / tu
tie
Detailed description of work to x,(��
be included on this permit only
PRIMARY PHONE
�EMa A/a4ta t a �h � 2S3 220 7SNIS
PROPERTY OWNER �ILIN nnn ss
� �t2�' Mc°��'n
CI�F�ec(e r aool W STATE ZIP CDMC Q Son .nip
NAME
PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE UBI N
NAME ■,/QI PRIMARY
PHONE
N/
APPLICANT MAILING ADDRESS E-MAIL �
4Drl A cvfK QSy �
CITY STATE ZIP
FAX
NAME A ' PRIMARYPHONE
G�.
PROJECT CONTACT �V
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondenceconcerning this application) CITY STATE zir FAX
NAME
PROJECT FINANCING OWNER -FINANCED
lL'ilen value is $5., 000 or more MAILING ADDRESS, CITY, STATE, ZIP � � PHONE
(RCW 19.27.095)
7�� v
� certify under penalty of perjury that I am the property owner or authorized agent o, f the propertr� owner. I certify that to the bed
of my knowledge, the info ation submitted in support of this permit application is true and correct. I certify thatl will comply with
all appric le City of Pe ral Wa
y regulations pertaining to the work authorized by the issuance of a pe it& I understand that the
i.ssuance of this permit aloes not remove the owner's sponsibility for compliance with local.. state, or federal laws rerr,�r.Y+�..�
� or�strucfion
or environmental
laws.,
� � �a�'.''"'"�y
.. .■ --
-. _.�_, j.� ���� fir.
i��� Z�_ !'lSL_ _t w_ � r M� _ � . .. � �'
l jurrner agree zv nuzu..urr■«ems g;ne L;zzy of recxerat way as to any elatm (includIIing costs, expenses, and attorneys', fees incurred art
the invest�ga�ian and defense o f such claim),, may be Meade by any person., including the unders-�gnea� and filed against th,- C'i�
but only where such clam arises out of the reliance of the city, includin,llits of, facers and employees, upon the ac�ura '
iy1fo ation supplied to the city as a part o, f this application.� °'f the
SIGNATURE:
PRINT NAME1W
,DATE
Bulletin# 100 —February 19, 2020
Page 1 of 2
k:\Handouts\Perm1t Application
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1N1ECHANICAL PERMIT
.;;rn�te dzow manlofeacht
SIR HANDLING UNITS
AIR CONDITIONER
WEEMba ------ BOILERS
COMPRESSORS
DUCTING
.P.-I.,UNIBINd
PERMIT
e of fixture to be installed or relocated as
Indicate how many of each type o
BATHTUBS (or 7'ub/shower combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPING
VALUE OF MECHANICAL WORK
art of this project. Do not include existing fiuctures to remain.
GAS PIPE OUTLETS
HOODS (commercial)
HOT WATER TANKS (Gas)
REFRIGERATION SYST
WOODSTOVES
OTHER (Describe)
VALUE OF PLUMBING WORK
`fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
LAVS mana sus) TOILETS WATER PIPING
RAINWATER SYSTEMS
SHOWERS
SINKS (kitchen/Utility)
SUMPS
lIft-WUSAM-61
VACUUM BREAKERS
WATER HEATERS (Electric)
WASHING MACHINES
OTHER (Describe)
TOTAL FEKTURES
GEN'FRAL I�vroRM'ATiON
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EMSTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Ei Yes o No
Ei Yes o No
Bulletin # 100 — February 19, 2020 Page 2 of 2 k:\Handouts\Pe it Application
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