22-100365-SF-Permit Application-02-04-22-V2CITY OF,.� PERMIT APPLICATION
PER
Federal Way MIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentei@cityoffederaiway.com
PERMIT Nupga R 2-2- - e� _
--- — Z O — -- 3 — — 6' F TARGET DATE
SITE ADDRESS
SUITE/UNIT #
w 3 �� �-� 5���-F �'-� g o 23
PROJECT VALUATION
ZONING
ASSESSOR'S T /PARCEL #
TYPE OF PERMIT
SING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRB PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
1.
Detailed description of work to
be included on this permit only
N
PRIMARY PHONE
PROPERTY OWNER
MA INGADDRESS
E-MAIL
.44 4116
city n
t' ,�4� �
STATE
LJ A�
ZIP
g $D W
NAME �^/
V
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY STATE
ZIP
FAX
N
PRIMARY PHONE
PROJECT CONTACT
o d�
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
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 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 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 claimf, whit y made by any person, including the undersigned and filed against the city,
but only where such claim arises out of the hance of he city, including its officers and employees, upon the accuracy of the
information supplied to t ity as a part his apptica n.
SIGNATURE: DATE
PRINT NAME:
Bulletin 4 100 -- February 19, 2020 Page I of 2 k:lHandoutsTermit Application
MECHANICAL PERMIT
VALUE OF MECHANICAL WORK
$ ov
Indicate how many or each type of
fbcture to be installed or relocated as
part 9f this project. Do not include ti res to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS Ic ,P, ig
BOILERS
FURNACES HOT WATER TANKS �G�]
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
�J
DUCTING
GAS PIPING
WOODSTOVES
PLUMBING PERMIT
VALUE OF PLumBING WORK
$ -5- 1000
Indicate how many of each type o
re to be installed or relocated as
part of this proLect. Do not include existin res to remain.
BATHTUBS 1—Tubisb—comb.)
LAVS
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
_ DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
_ SINKS (mtrt h—/utiuLy)
WATER HEATERS (EIectric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
NO
WATER PURVEYOR
�4y a F . 1A eto Ma
SEWER PURVEYOR
GA e- IVA e„!
VALUE OF F. XM771M IMPROVEMENTS
EXISTING/PREVIOUS USE
nc J d
�v.
S
LOT E (In Square Feet)
[a Z-7 5-
_ (
EXISTING FIRE SPRINKLER SYSTEM?
Li Yes No
� N,
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ AReside
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
gf8,5
A w
........................................................................................
SECOND FLOOR
COVERED ENTRY
..................... -.............................. ......- ---- ................... -.....................
DECK
..................................... .............................. ......._.................................................
GARAGE ❑ CARPORT ❑
.....................................................................................I.............................
OTHER (describe)
..........................................................................................................................
Area Totals
EXISTING
PROPOSED
TOTAL
....................................... . .................. _...........................................................
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $
j
# OF BEDROOMS [
COMMERCIAL— NEW/ADDITION
AREA DESCRIPTION
Area in
S meet
Occupancy Group(s)
Construction
# of
Stories
Additional Information
NEW BUILDING
ADDIT
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Are
are Feet
_Sqlyp
Occupancy Group{s)
T Construction
e
# of
Stories
Additional Information
TOTAL BUILDING
TENANT,A61EA ONLY
PROJECT AREA ONLY
Bulletin # 100 — February 19, 2020 Page 2 of 2 k:lHandoutslPermit Application