10-102332 M Federal Way _ ERMIT Z CO ME EL PL DE EN F (P--r
APPLICATION /
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253-835-2607•FAX 253-835-2609
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SUITE/UNIT O J •G 4403 ZONING ASSESSOR'S TAX/PARCEL II / I
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(Tenant or Homeowner Name) 11111 OI- r wf f C-G1 a a l — Lot S 2A 9
I BUILDING ® PLUMBING litillECHANICAL
TYPE OF PERMIT 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
PROJECT DESCRIPTION C,oriStruCticv - 'Jinp k �df'i11I KeS(C
Detailed description of work to 7
be included on this permit only 3 Lev-.
WPM 77: 3' .�,% f ; - �x7 .i/nice ,. s :,Ten��� gym, �' /07/"1 r
lam/ y a c r`, ,�i,
oN � ,.y'x ��;� „�� _,. ��
NAME PRIMARY PHONE
PROPERTY OWNER L 7' -(I f �C- bet p. I. I40 r) (425) SW - 314-00
MAILING ADDRESS,CITY.STATE.ZIP E-MAIL
12119 i tie 124-H1 1f14(e, k-I c S.o 4—
OWNER IS ALSO: FatCONTRACTOR Eat
�•-il l `APPLICANT+ ' PROJECT CONTACT
NAME �t lY t L.1.L1-1-6O b .: , y.I o r-kir PRIMARY PHONE
(�2�) BZ( - 3400
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
► IE 1210-Fh ra , � r -�.o 0 ( ) -
WA STATE CONTRACTOR'S LICENSE IF - EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
DI2-44 cite.61 fob / 3 n
APPLICANT NAME C iitraCtUr ( 1 PRIMARY PHONE
MAILING -
ADDRESS,CITY,STATE,ZIP 1 FAX
( ) -
PROJECT CONTACT NAME . PRIMARY,iPH �cONE" -i 1 i
(The individual to receive and V►tI 1 S t % Sre Uin (42 b C.1' -00 35
respond to all correspondence MAILING ADDRESS,CITY.STATE,ZIP FAX
concerning this application)
(S11 ) 2g IaJ - �bCv l
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
(' ) - . . Crb owl'ICdrhariD11.c aim
PROJECT FINANCING NAB i n,�, r-�
Required for projects with
cons .I Di j 110 4C)1 C Er-OWNER-FINANCED
value of$5,000 or more MAILING ADDRESS.CITY.STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) ( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I cert(fy that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city asa part
�of this application.
SIGNATURE: fI/OA/JI "..i-- DATE 6/4/I/
PRINT NAME: V Ii'i htt.e rV k)f
Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application
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• Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Tndicate number of each.type o Jiactur�be Installed or relocated as pares proJeW. Do not include _ res to remain.—
- AIR HANDLING UNITS (p FANS — GAS PIPE OUTLETS OTHER(Describe)
- AIR CONDITIONER I FIREPLACE INSERTS HOODS(Commercial)
— BOILERS I FURNACES I HOT WATER TANKS(Gas)
COMPRESSORS — GAS LOG SETS REFRIGERATION SYST
DUCTING 41— GAS PIPING WOODSTOVES
.PLYING 4 RE
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) It LAVS(Hand Sinks) 3 TOILETS I WATER PIPING
I DISHWASHERS — RAINWATER SYSTEMS — URINALS OTHER(Describe)
— DRAINS I SHOWERS VACUUM BREAKERS
— DRINKING FOUNTAINS I SINKS(Kitchen/Utuutyl WATER HEATERS(Eleatic(2. HOSE BIBBS SUMPS I WASHING MACHINES I 10 TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 111-l-, logo. o o Lakehoetr) ufi l 1 1 kt Maven t h I;{y $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
5121 ❑Yes iNo 0 Yes tit No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT ,
FIRST FLOOR(or Mobile Home) f0�/
SECOND FLOOR ( (O — — — ---
. C0
COVERED ENTRY
7J
DECK -,---
GARAGE 11 CARPORT ❑ (S --- 36 0
OTHER(describe) .--
EXISTING prtarosenf TOTAL ,
-- ----
Area Totals iO�1 . D-5 '
:*NEW HOMESp(� ONLY••
174
ESTIMATED SELLING PRICE$ % ) I 1 S, 0 0 #OF BEDROOMS
COMMERCIAL NEW/ADDITION'
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL -REMODEL/TENANT/IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2010 Page 2 of 4 k:\Handouts\Pennit Application