21-100098-SF'11111;&
CITY of
Federal Way
PERMIT NUMBER C2 1
SITE ADDRESS
PROJECT VALUATION
TYPE OF PERMIT
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2507 + FAX 253-835-2609 + t,-.;:1:.•.; , ; ;,.IIyUI-ft'dttIalway--
c 7 TARGET DATE
sulT�luxlT r
,�.e �� ��.d�2�a � we r.�r►� � goy
gp I} ASSESSOR'S TAEIPARCEL ■
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of want to
be induded on this permit only
PROPERTY OWWEIt
CONTRACTOR
APPLICANT
PROJECT CONTACT
(Me individual to receive and
respond to all corresponde—
Concerning this app&cation)
PROJECT FINANCING
When value is $5,000 or more
(WC W 19.2709.51
>t BUILDINti �'LUMBINCS � MFcijANfCAL []DEMOLITION
� ENGINEERING 0 FIRk )'REVENTIDN
X 1 STta&y *A'E'
PRIN)MY PHG3i&
"Amy, I�� -7 >StAA� ,>)-D6,2o*12b0
uarr_nrGADURESS
8-1E1l1Lr_n Q��
CITY
STATS —��2-3
r
IYIIIYB C2NAlete-
[ NTr
PHONE
N ALMING ADDRESS
IUIIAIL
CITY
$TATE
ZIP
FAX
WA STATE CONTRACTOR'S LICXNKt N EXPIRATION DATE
IIHI R
I I
liA>SS3
n
Ids
PR/}i>tfAR4PHG1iS�
.L. 3
NIAII.ING ADDRESS �
� � � � � f� �
>�1NAI4
C2041vey
/
FAX
NAY& Jo , , _'� y
�Ds- fAAAc�'
PRDLARY PEIORE
I }�
V V
V `T 1 l-
3 12
Q�
7 r i l' e 9-w
`
CM,
Z" Q" Q-3
FAS
IiAI[S6
a pW[IER-FIILANCED
MAILING ADIGRESS, CITY, STATE, ZIP
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best
of my knowledge, the Warmallon submitted In support of this permit application is true and correct. I certgy that I will comply with
all applicable City of Federal Way regulations pertaining W the work authorized by the Issuance of a permit. I understand that the
issuance of this permit does not remote the owner's responsiMaty for compliance with local, state, or federal laws regulating
construction or environmental larva.
I further agree to hold harmless the City of Federal Bray as to any claim (including costa, expenses, and attorneys' fees incurred in
the Investigation area defense of such clainq, which may be made by any person, Including the underzigne4 and filed against the city,
but only where such claim arises out of the reliance of the city, including its offleers and employees, upon the accuracy of the
information supplied to the city a port of this appIieatlon. [� � r
SIGNATURE:
DATE vJ' • J ! O ��A �-Y
y
PRINT NAME:
Bulletin # 100 - February 19, 2020 Page I of 2 Ul landoutslPcrmjt Application
VALUE OF MECHANICAL WORT{
MECHANICAL PERMIT s
Indicate how nulpty of each LiWe offixture to be installed or relocated as Part of this PrOjed. DO not include existing wtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODSIc��;■y
BOILERS FURNACES HOT WATER TANKS jo*
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE F PtUMBING WORK
PLUMBING PERMIT
`�4 ? -/
Indicate how mmxny of each tupe of
re to be installed or relocated as part of thiseroject. Do not include existirigfaWres to remain.
BATHTUBS
LAVS (Ha dSiakw �
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRIN-KINO FOUNTAINS
,_ � SINKS ix"-h—xtihm
WATER HEATERS (Eke )
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIILZDRES
GENERAL INFORMATION
rnrrwAL ARZAA ON P"PER'PYP Wiffm PURVZTOIt swmm rusveTwe VALVZ OF ENE= uumovickm=s
ZZEF Q/PRZVWUB uss LOT sIZE ¢n sqn Feet" ExisTwo FmZE sPR]UIu" sTffmm;? FROPomm f+'= SUPPREMOW 9TS7xm7
-! ElYeSA No ❑ Yes A No
RESIDENTIAL -NEW OR ADDITION
AREA DESCRi TIOX (in square feet) EMSTOG PROPOSED
TWAL
FOR OFFICE use
BASEMENT
FIRST FLOOR for Mobile Hamej o ,41' <97
per"` 1
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 13 CARPORT ❑
OTHER (desc ri"
cnsr�ru
Area Totals
Torsi.
—MV HOAZ3 ONLYY"
ESTIMATED SELLfNG PRICE $ 1 # OF BEI)kQOMS
COMMERCIAL — NEWIADDITION
Area it nP+mGy iiroup(sI
AREA 17EBCRIPTIOR
Cons ra tinn
Type
# Of
Stories Additional Informatioa
nary Feet
Nzw Bu a nnta
ADDMON
COMMERCIAL--REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area urea i net
Occupancy Group{:)
Construction Ty"Stories
Of
Additional Information
TOTAL BfJtLDf G
TISRAart AREA ORLT
PRwecr AREA OHZ.T
Bulletin # 100 — February 19, 2020 Page 2 of 2 k:IlfandoutsTcrmit Application