23-101335 - Permit Application - 3-13-23FederalCITY OF
a
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentel@cityoffederalway.com
- TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAIL/PARCEL #
TYPE OF PERMIT
V BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
j i� Cq ,(� �IVI ,n 1
I �` fJV
PROJECT DESCRIPTION
Detailed
L
g
description of work to
be included on this permit only
NAME �
eJ
v� � V- I K(I
PRIMARY PHONE
2153 . 235 • 543
PROPERTY OWNER
MAILING ADDRESS
3ozbt Z '�� V�.Slc1(
E-MAIL
�C ItjV-f Wo 430 (1HA)
CITY 'a•
STAT I
ZIP
NAME � � � � � �
PHONE
Zoe• q�•l • 5g
MAILING ADDRESS • _ ' - ^
�•`/JC�IV�/✓_ �f/^
�MO1WVV T O d
CONTRACTOR
CITY ••9SV(
1 `A/�
W jSTATF�
R
ZIPA�
(E'XPIRATION
FAX �•' L • �6
WA STATE CONTRACTOR'S LICENSE _# DATE
ve u G -19 + ' 2 / z. / z�
NAME t
UBI #
Cpa iR�3- b
PRIMARY PHONE •
Ze • 3�
MAILING ADDRESS
1 21"
EMAIL
R��r�d R�uG�4t
APPLICANT
CITY OIJN f�
STATE9
ZIP /I- ��y
q
FAX
PROJECT CONTACT
NAME ` l � �
(�T�'I`�'
PRIMARY PHONE
2'IT3
(The individual to receive and
MAILING ADDRESS
EMAIL
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME i'
iY, Qny Tim,
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 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 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 pa is application.
2
SIGNATURE: DATE ✓
PRINT NAME: t�`� !✓ �� IS-
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Bulletin #100 - February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
J�
VA
MECHANICAL PERMIT LUE OF MECHANICAL WORK
Indicate how many of each type offtxture to be installed or relocated as part of this project. Do not include existing a--tures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commerca )
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMDING PERMIT
VALUE OFPLUMBING WORK
Indicate how many of each type of lixture
to be installed or relocated as
part o this project. Do not include existing, res to remain.
BATHTUBS (or Tub/Shower combo)
LAVS (Hand Sims)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/utiiity)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR •
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
�IVV s-tl At-10
LOT SIZE (In Square Feet)
((j b
•
EXISTING FIRE SPRINKLER SYSTEM?
Li Yes �No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes �' No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
------
--------------- -........ - ... --- -------- ---- - -...
FIRST FLOOR (or Mobile Home)
- -
--_......... -- .............. - _ _ - - - --- - -- -
SECOND FLOOR
- - -
— —-._....---------- _...... - - -_ - .._.--- ------- --.........
COVERED ENTRY
.................
--........... -- - - ------------------------....- .........
DECK .
492
492
..................................
GARAGE ❑ CARPORT ❑
-.......... _....... - ... ... -............. ---.---.......................... -- -
OTHER (describe)
---... -............. ------------ ------------ - - -- - -
Area Totats
EXISTING
492
PROPOSED
TOTAL.
492
- = ---
--- -- -------.-_------ --......... _...... ....... .........
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE
I # OF BEDROOMS
COMMERCIAL - NEWIADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW ,BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Sguare Feet
Occupancy Group(s)
ConstructionStoriesType
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREN ONLY
Bulletin #100 - February 19, 2020
Page 2 of 2
k:\Handouts\Permit Application