22-104856 (2)CITY OFVAA�&
PERMIT APPLICATION
PERMIT CENTER + 33325 8� Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter a cityoffederalway.com
PERMIT NUMBER I I � � — /a— ) — ^ dC 6 ,2�
�% i 2+ _ _ TARGET DATE l
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ /0 000
7 D 02_
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
ge -
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
r-
C
PROPERTY OWNER
NAME
MVl S
PRIMARY PHONE
Y7 794
MAILING ADDRESS
Aq
E-MAIL
CITY
Rt- N
STATE
ZIP C
�J
NAME
PHONE
w
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
C
PROIARY PHONE
MAILING ADDRESS
s�
E-MAIL
APPLICANT
CITY
S`TA'TE
�"�
ZI
'PAX
PROJECT CONTACT
NAME
/j"--�
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 Wormation 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 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 as apart of thisapplication.
SIGNATURE: o G ( 9.� • "�f DATE 1
PRINT NAME: 76&M Are% ft 'A R-Y
vy1
Bulletin #100 February 19, 2020 Page 1 of 2 k:lHandouts\Pennit Application
VA
I.UF. OF MECHANICAL WORK
MECHANICAL PERMIT ��J� �
Indicate how many o each type offixture to be installed or relocated as part of this project. Do noLcludee;dstingfixturesto remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS )commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
N
$
Indicate how many o each type offixture
to be installed or relocated as
part o this project. Do not include existirkg urtures to remain.
T_ 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/utilirA
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
$ , V d O
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINIMER SYSTEM?
PROPOSED FINE SUPPRESSION SYSTEM?
d rJP
Yes'C No
❑ Yes X No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
/ b`
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
EXISTING
PROPOSED
TOTAL
=W HOMES
OAILY""
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS _
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Upe
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDINO
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\Handouts\Pennit Application