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22-103015-Permit Application-07-01-22CITY OF - Federal Way PERMIT NUMBER Z Z_ PERMIT APPLICA'T'ION PERMIT CENTER+ 33325 811, Avenue South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + permitcentel a)cityoffederalway.cam 1 ,0 3 v ) ---- TARGET DATE SITE ADDRESS SUITEMNIT # :5,2607 39 '" AvG SW? Ft-bit tA)A4. I UJA o 23 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # $ 2-0 o oc 1 9- 23- t h- 1 TYPE OF PERMIT BUILDING ❑ PLUMBING ❑ MECHANICAL © DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT C'TAF_A&e Cooqi25 � PROJECT DESCRIPTION Detailed description of work, to I h w A C-AA be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS? S.W. J++ L 1 -32669 ? At , W • E- L O' Y1'll' i [ LI O CITY STATE ZIP OA NEE PHONE MAILING ADDRESS E-MAIL CONTRACTOR CITY` STATE ZIP FAX WA STATE CONTRACTOR'S LICENSE # - EXPIRATION DATE UBI # NAME CI)Obi PRIMARY PHONE ci K APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP PAX NAME PRIMARY PHONE PROJECT CONTACT MAILING ADDRESS \ 326 � hlx S� E-MAIL-` ` } i j dorl 4Gp (The individual to receive and respond to all correspondence Y}L`FyiJ,et " CITY � flit✓ STATE �A ZIP CleoZZZ FAX concerning this application) PROJECT FINANCING NAME ❑ OWNER FINANCED When value is $5, 000 or more (RCW 19.2Z.095) MAILING ADDRESS, CrTY, STATE, ZIP PHONE I certify under penalty of perfury that I am the property owner or authorized agent of the property owner. I cert(N that to the best of my knowledge, the information submitted in support of this permit application is true and correct. I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, Including its officers and employees, upon the accuracy of the information supplied to the city as apart is application. SIGNATURE: DATE PRINT NAME: /� . "I Bulletin # 100 —February 19, 2020 Page 1 of 2 Ul-landouts\Permit Application h VALUE OF MECHANICAL WORK MECHANICAL PERMIT J$ Indicate how many of each type of lixture to be installed or relocated as part o this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial) BOILERS FURNACES _ HOT WATER TANKS (Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OF PLUMBING WORK PLUMBING PERMIT $ Indicate how many of each t e o re to be installed or relocated as art a this ro'ect. Do not include existi res to remain. BATHTUBS (.,T,b/Sh.w,rCnmhu) LAVS plandshnk.) TOILETS WATER PIPINGS DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAI{ERS DRINKING FOUNTAINS SINKS (Kitchen/Utility) WATER HEATERS (EIe Ie ic) HOSE BIBBS SUMPS WASHING MACHINES TOTALFIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR SEWER PURVEYOR VALUE OF 9X'SIMPROVEMENTS EXISTING/PREVIOUS USE WT SIZE 11n Square Feet) -- - I EXISTING FIRE SPRINKLER © Yes o No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION (in square feet) I EXISTING I PROPOSED I TOTAL BASEMENT FIRST FLOOR (or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER (describe) EXISTING pROPOSEI) TOTAL. Area Totals **ra w90_=s ONLY" ESTIMATED SELLING PRICE $ A OF BEDROOMS PROPOSED FIRE SUPPRESSION SYSTEM? c Yes ii No FOR OFFICE USE Bulletin 4100 -February 19, 2020 Page 2 of 2 k:lHandoutslPerinit Application