22-104803 (2)CITY OF 4A
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 811� Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + perrnitcentet(r�-ciryoffederalway.com
- TARGET DATE
SITE ADDRESS
2 �� S 3 17 ^ Fe ctt d w l L 6/l/ 7 9 003
SUITE/UNIT X
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PAR L N
$ 30rV-�
3 5- 9 4 d- (�
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECH:INICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
I u-5 w R e m o d4 �v 14 �ad o?—
e l
PROJECT DESCRIPTION
)
Detailed description of uaork to
L o `
be included on this permit only
NAME
- ,4
PRIMARY PHONE
6 6
PROPERTY OWNER
ADORES
II, &MA
STATE
ZIP
✓e L
U
LCL/
L LNAME
PRONE b C2 - 6 9 0 3
MAILING ADDRESS I
' Giai
E-MAIL
� j V � e
CONTRACTOR
CITY
STATE
ZIP
F
o
WA STATE CONTRACTOR'S LICENSE r
EXPIRATION DATE
UE1 i
—
o aG
1 4
A, s
NAME
PRIMARY PHONE
S-- 0 3
MAILINO ADDRESS !I
E-MAIL
APPLICANT
CITY
STATE-.
IT � V � U
FAX
N E
PRIMARY PRONE
PROJECT CONTACT
6 6 g, L)
MAILING ADORES �31-7' ` , f
17V I 'f
E Mpn
(The individual to receit,e and
respond to all correspondence
)wa, tv Cs
CITY
STATE
zlP g
FAX
I
concerning this application)
PROJECT FINANCINGUS
OWNER -FINANCED
6t7ten value is $5,000 or more
(Rcw 19 27 095)
MAILING
I ADDRESS, �'NEq'� C'tDD/ C
HONE
t
i 6 L) 3
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 trice and correct. I certify that I will comply with
ail 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 a part of this application_
/r L,2- 2
SIGNATURE: DATE
nn
PRINT NAME:t�-
Bulletin 0100 - February 11), 2020 Nlpv I ul 2 LA-ImidoutrPernut .Application
1v1-a 1
'1a�SKJI
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT Is 5-2D
Indicate how many o each type o mture to be installed or relocated as part o this project. Do not include exist' rxtures to remain
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (c...—.,dt
BOILERS FURNACES NOT WATER TANKS Io..1
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how many of each typeoffixture
to be installed or relocated as
gart of this project. Do not include exiltingfUtures to remain.
_ I BATHTUBS (or TUblsho , Combo)
LAVS IH-d Mokq
TOILETS
WATER PIPING
DISHWASHERS
DRAINS
RAINWATER SYSTEMS
SHOWERS
URINALS
VACUUM BREAKERS
OTHER (Describe)
DRINKING FOUNTAINS
�� SINKS 1X.wh1./Uld.lh
WATER HEATERS (ammo
HOSE BIBBS
SUMPS �_ WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALVE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE Ila Square Feet)
EXISTING FIRE SPRINKLER SYSTEM? I
Yes ?(-No
PROPOSED Pwis BVPP�RESSION SYSTEM?
zi Yes & No
RESIDENTIAL - EN'N OR ADDITION
AREA DESCRIPTION fin square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
i#145EMF.NTsaS
FIRST FLOOR for Mobile Home)
^aECOND FLOOR
COVERED ENTRY
a.
GARAGE ❑ CARPORT ❑
Area Totals
EXISTING
PROPOORD
TOTAL
—OF
ESTIMATED SELLING PRICE $
t7
COMMERCIAL — NEWADDITION
AREA DESCRIPTION
Area in
SquareFeetType
Occupancy Group(s)
Construction
# of
Stories
Additional Information
NEW BUILDING
}' '55' -
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
N of
Additional Information
Square Feet
a
Stories
BA.LGDINO
TENANT ARFIA ONLY
u f •'lr AREA ONLY.
Bulletin #100 — February 19, 2020 page 2 o1•2 k:\HandoutsTernia Application