23-100967-SF-Permit Application- 3-1-23I PERMIT APPLICATION
CITY OF
PERMIT CENTER + 33325 8i1' Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenterracityoffederalway.coin
PERMIT NUMBER
- TARGET DATE
SITE ADDRESS
SUITE/UNIT #
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PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL M
TYPE OF PERMIT
MBUHMING ❑ PLUNIHING ❑ MECHANICAL ❑ D1:MOI.ITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
V0 U L. + JI
Detailed description of work to
oo -5 '
be included on this permit onlyt
NAME
PRIMARY PHONE
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PROPERTY OWNER
MAILING ADDRESS
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E-MAIL
Cc 5s r _ - P t,e
CITY
STATE
ZIP
W it
NAME
PHONE
_. -e�S
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
I
WA STATE CONTRACTOR'S LICENSE 8
EXPIRATION DATE
UBI N
NAME
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PRIMARY PHONE
-1�-AO5-5Da 3
MAILING ADDRESS
1 1 L� S
E-MAIL
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APPLICANT
CITY
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STATE
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ZIP
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FAX C
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NAME
PRIMARY PHONE
PROJECT CONTACT
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
(RCW 19.27.095J
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 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 Iaws 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 application.
SIGNATURE: au®DATE
PRINT NAME:
Bulletin 4100 - February 19, 2020 Page 1 or 2 Ul IandoutslPermit Application
VALUE OF MECHANICAL. WORK
MEC ANICAL PERMIT $
Indic to how many of each type offLxture to be installed or relocated as part of this project. Do not include existing res to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS )Commercial)
BOILERS FURNACES HOT WATER TANKS (cell
OMPRESSORS GAS LOG SETS REFRIGERATION SYST
UCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLU BING PERMIT
�
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing fixtures to remain.
BATHTUBS I.,T,.h/Sh.—,C—b.)
LAVS lHendSinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchm/Utility)
WATER HEATERS (6me16q
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING JPREVIOIIS USE
LOT SIZE Iln Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Yes L No
i- Yes c No
RESIDNTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND LOOR
COVERED ENTRY
DECK j
GARAGE F CARPORT ❑
OTHER (describe)
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY**
SELLING PRICE
# OF BEDROOMS
FOR OFFICE USE
COMMERCIAL — NEWIADDITION
Area in Construction # of
Additional Information
AREA DESCRIPTION Square Feet Occupancy Group(s) T e Stories I
NEw BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin ill 0 -February 19, 2020
Page 2 of 2
k:1llandoutslPermit Application