10-103643[ITY OF'}
Federal Way
COMMUNNY➢Ei+ OPAiENTSERVICES
253-835-2607- #r K 2W-SSS-2609
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PERMIT
APPLICATION
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PROPERTY tr: anI
SITE ADDRESS -
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SUITE/UNIT #
ZONING ASSESSOR'S TAX/PARCEL #
PROA CT.x_M. l it •.;
NAME OF PROJECT
(Tenant or Homeowner Name)
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TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ fl ARE
DEMOLITION ELECTRICAL ❑ENGINEERING PREVENTION
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PROJECT DESCRIPTION
❑etaited description of work to
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be included on this permitonly114w
PEOPLE
NAME
PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS, CITY, STATE, ZIP
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F1 CONTRACTOR APPLICANT PROJECT CONTACT
OWNER IS ALSO:
HAMS
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IJONE
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MAILING ADDRESS, CITY, STATE, ZIPVIA
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FAX
CONTRACTOR
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EXPIRATION DATE
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NAME
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Y PHONE!
APPLICANT
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MAIMAG kESS. CI . STATE. ZIP
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PROJECT CONTACT
NAME
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PRIMARY PHONE
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MAA.IiIIG ADDRESS, CITY, STATE, ZIP ,�/ �!
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FAX
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respond to all correspondence
concerning this applicatWn)
A,LLITER�N,ATE COjNTJACT�jNAME:
7 PRIMpA/R�Y PHONE�'+!r
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PROJECT FINANCING
NAME
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OWNER -FINANCED
RegUired for projects witit
MAILING ADDRESS, tTY. STATE, ZIP
PRIMARY PHONE
vatue of $5.000 or more
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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 authorised by the issuance of a permit. I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with focal, state, or federal laws regulating
construction or environmental laws.
Ifurther agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attarneys' fees incurred
in the investigation and defense-s)Ach claim), which may be made by any person, including the undersigned, and filed against the
city. but only where such claim - es out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the cltyr apart of this application.
SIGNATURE: / � DATE
PRINT NAME:
Bulletin #100 - 4/21/2009 Page 1 of 4 k:�Handouts\Permit Application
MECHANICAL FIXTURES
Value o Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (commemial) & 5 s 4E66
BOILERS
FURNACES HOT WATER TANKS (cas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
PLUMBING
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existingfixtures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Eieomo)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING DYIPROVEMENTS
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$
EXISTING/PREVIOUS USE
MNle
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes,*' No
PROPOSED FIRE SUPPRESSION SYSTEM?
kYes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
�—
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
EXISTDiG
PROPOSED
TOTAL
"NEW HOMES ONLY"
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL
- NEWADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
jUe
# of
Stories
Additional Information
ANEW BUILDING
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A�prrlelr �yEoY
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in S uare Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
67,'742
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Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application