22-105430-Application-12.02.22CITY OF ` PERMIT APPLICATION
PER
Federal Way MIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenterCcityoffcderalway.com
PERMIT NUMBER _ _
— — — — — —.. — — — — TARort'r DATE
SITE ADDRESS
SUME/UNIT R
30 lj6 3" Pt 5 Fcdl-fta w w A oD 3
PROJECT VALUATION
ZONTRG
ASSESSOR'S TAX/PARCEL R
$ asoda°-
_& -6- --1— —2--
TYPE OF PERMIT
la BUILDING YJ PLUMBING ❑ MECIIANICAL 11 DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
S t~ (-G re
f +1 3 rb a Y'2- 64141%roor^ 1 t,.7:i! �c t-ti^+►^ t /`
PROJECT DESCRIPTION
Detailed description of work to
{ 4 ran Y b-411I'2M. 1 w i% I Y`9 4- "dof k r r
1 w l► dx_ [ �i n ` r Du ctS '. n OU Cf A-t ova 1
be included on this permit only
. %k &jj OL raw+ ; dam ' p► A Use_ W ` ^s e C b ram -
NAME
PRIIAARY PHo
PROPERTY OWNER
MAILING ADDRESS
3Z"73$ Zrd id +ram Sf.•�
EMAIL
r- a.4 ZI rInl.
CITY
Fe&a-(Cj w Imp,
STATE
ZIP
916cEQ3
NAME
PHONE
KMMG ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
zip
FAS
WA STATE CONTRACTOR'S LICENSER
EXPIRATION DATE
USI R
NAME
i m 4,, ArS ,)
PNIMepY PHONE
ao - ;L -16 ` c�
MAILING, ADDRESS
S-' 1I 'b
E-MAIL
APPLICANT
CITY
Fe t� a_ ps w
STATE
WA8g
ZIP
C z 3
FA%
NAME
'� Ira
PRIMARY PHONE
D_00 -a t'& `
PROJECT CONTACT
I A,
MAILING ADDRESS r�
2 3 'b -Sw
E.MAIL
(The individual to receive and
respond to all correspondence
CITY
F c� w
STATE
wa�
zip
1 aa3
FAX
concerning this application)
PROJECT FINANCING
NAME
0 OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
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 cert(fg 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 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 local, state, or federal taws 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 craiml, which may be made by any person, including the undersigned, and flied 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 city as a part of this application.
SIGNATURE: DATE
PRINT NAME: M��t;a n w . P�s�•�
Bulletin i1100 - February 19, 2020 Page I or2 k:UlandoutslPcmtit Application
t.
VALUE OFMECHANICAL WOW
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part o this project. Do not include existingfEdures to remain.
AIR IIANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODSIc...—w)
BOILERS FURNACES HOT WATER TANKS ca..i
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OFPLumBiNG WORK
PLUMBING PERMIT d.
Indicate how many of each type ofjixture to be installed or relocated as Part-9f this ProJect, Do not include extstm 0c'Wres to remain.
1 BATHTUBS for r h/sh—, C..b,4 IAVS iH..d Sae,( 3_ TOILETS ✓ WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS l SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS 3 SINKS Iwuh—/umiryl WATER HEATERS W. i
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF ERISTIN6 IMPROVEMENTS
EXISTINO/PREVIOUS USE
I.OT SIZE Ila Squ— Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
0 Yes ❑ No
❑ Yes ❑ NO
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feetl
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Homel
3 bc-1 room3
$edrpo
T
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
CKMT a
—POSED
T111
**NEW Tvo—=rs omY* *
ESTIMATED SELLING PRICES
=40FEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area In
Square Feet
Occupancy s
p y Grou P1 1
Construction
Type
A of
Stories
Additional Information
NEW HUILDIIIG
ADDITION
COMMERCIAL - REMODEUTENANT IMPROVEMENTS _
AREA DESCRIPTION Area in Occupancy GrouPlal Construction N of Additional Information
Square Feet Type Stories
TUTAL BUILDING
TENANT Akt;A ONLY
PawzCT AREA oxim
Bulletin 0100 - Febmary 19, 2020 Page 2 ni 2 k:111andotllslPermit Application
FVALIUIE OPMECHANICAL WORK
MECHANICAL PERMIT 5o�ce
Indicate how many of each type offixture to be installed or relocated as purt of this project. Do not include exisLbWfixtures to remain.
AIR HANDLING UNITS r-.— FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSCRTS HOODS (CwnwM-11
BOILERS FURNACES HOT WATER TANKS In..)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUAfBING WORK
PLUMBING PERMIT
s
Indicate how many of each type ofrExture
to be installed or relocated as
part of this Vro ect. Do not include existing Ixtures to remain.
BATHTUBS IarTuhfShowerCam6o1
LAVS IH-dSin3mj
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS ignahe./Ul Idyl
WATER HEATERS (Ei—rwI
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIRTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF HRISTINO IMPROVEMSNTS
EMSTINGI PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTDIO FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes o No
RESIDENTIAL —NEW OR ADDITION
AREA DESCRIPTION (in square feet]
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE El CARPORT 0
OTHER (describe)
_—
Area Totals
i;;[I$TIPG
PROPOSEDTOTAL
—NEW HOMES ONLY" °
ESTIMATED SELLING PRICE
It OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feat
Occupancy Group(s)
Construction
a
M of
Stories
Additional Information
NEW BUILDING
AUDITION
COMMERCIAL —REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
B uare Feet
Occupancy Group(sl
Construction
c
If StoriesofAdditional
Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin H 100 - February 19, 2020 Page 2 of 2 kal landouixTermil Application