23-100081-Application-01.26.23CITY OF'��z
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-83S-2607 + FAX 253-835-2609 + permitcente .I cityoffederalway.com
TARGET DATE / r
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
15- 0
4 jf_5 `7 � _�__ -/- - D : &_ 0-
TYPE OF PERMIT
vUILDING ❑ PLUMBING L MECHANICAL ❑ DEMOLITION Lj ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
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Detailed description of work to
p
be included on this permit only
L i Cc
NAME
P IMARY PHONE
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PROPERTY OWNER
MAILING ADDk&SS
-MAIL
CITY
STA
ZIP
-
NAME ' ,
PHONE
Z-:6 3 �77ao
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MAILING ADDRESS
�E/-�IL
VC tST
CONTRACTOR
C Ty
STATE
ZIP
FAX
1el
MIA
WA STATE CONTRACTOR'S LICENSE a
3-7�
EXPIRATION DATE
UEI
6x7z11&, 7Z 7
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NAME
PRIMARY PHONE
Z53OM TTocs
MAILING ADDRESS
E-MAIL
APPLICANT
C
CIT
STAT
ZIP
FAX
NAME
PRI Y PHONE
PROJECT CONTACT
it f!
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MAILING ADDRESS t , / '
E-MNL ( r
(The individual to receive and
respond to all correspondence
It
CITY
f
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 19.27.095J
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. 1 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 a part of this applica '
SIGNATURE: DATE Dh'
PRINT NAME: AIALEZZ
Bulletin N100 — February 19, 2020 Page I of 2 k:lHandouts�Perlrlit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type offtrture to be installed or relocated as part of this project. Do not include existing fixtures to rernain
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS {Co¢vneTci.,)
BOILERS FURNACES HOT WATER TANKS Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUM13NG WORK
PLUMBING PERMIT
$
Indicate how many o each type offixture
to be installed or relocated as
part o this project. Do not include existing fixtures to remain.
BATHTUBS nor Tub/Sbo.,tr Cobol
LAYS SHa d Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kieobmli:t ivA
WATER HEATERS ]Eie r iq
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF IMPROVEMENTS
,EJUS77NO
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EXISTING/PREVIOUS USE
LOT SIZE IIn Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Yes - No
-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
LO7 SF
{ �✓�
-- -
GARAGE 111 CARPORT ❑
-
OTHER (describe}
Area Totals
E] 1n G
I PROPOSED
TOTAL
--NEW HOMES o y
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s)
Square Feet
Construction # of Additional Information
Type Stories
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area to
Square Feet
Occupancy Groupts)
Construction # of Additional Information
Type Stories
TOTAL BUILDING
€€
f !
TENANT AR2LA ONLY
I
i
PROJECT AREA ONLY
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Bulletin =100 — February 19, 2020 Page 2 of 2 kMandoutsTermit Application