23-100982-Permit Application-2-25-23CITY OF
Fedora
I Way
PERMIT APPLICATION WA 98003-6325
PERMIT + 33325 81h Avenue South + Federal WsYl
253-835-2607R + FAX 253-835-2609 + permitcenter@C1ty0ffederaWywC0m
PERMIT NUM13ER 0 q
iii'E ADDitm
93 q3 S 03.00-.0
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TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed descliption of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
(T179 individual to receive and
respond to all correspondence
conc�r�ing this application)
PROJECT FINANCING
"en value 1s $5,000 ar more
(RCW 19.27.895)
T DATE
�,,� A w4 00/
AfiEEfOR7 TAIUPMCEL
17 & &. ammp--I 0I -
DBUILDING. 13 PLUMBING � MEC
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deea �o/y ini��'
HANrcAL DEMOLITION
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WA STATE carrrrarraaPa ucENa �
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NAME
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NAME
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gXpIRATION DATE
//5 1 1.23
STATE ZIP
MtlYARY PHONE
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PHONE
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OWNER -FINANCED
PlIGNE
I csrtl under penalty of perjury that 1 am the property owner or authorized agent of the property owner. I esrtifjr that to the best of my knowledge,
� lrcatlan Is true and correct !certify Mat I will comply with all applicable City of Faders! Way
the lnformaUon submitted !n support of this perm!# app
re9 ulatlons pertalnlnp to the work au n ed 6y the issuance of a perm![. 1 un construction or nt � laws.that the Issuance f this permit
permit does not remove the owner's
responslhJllty for com�vlJance with 1 al, t fie, or federal laws regulating cons In the
!further agree to hold harnnles the 1 of Federal Way as to any claim (including � RAP �� � against
and �� S� �� �` but nly wive such claim�arJses
and defense of such clalmj, w gation
ms made by any p� , Including the undersigned,9
out of the reliance of the c1u in Its officers and e P1°Yves. upon the accuracy of the Information supplied to the city as a part of this
sppflcativn. I _
SIGNATURE:
PRINT NAME:
p/&111111 a
DATE
/0 az Ir?s 1A 044P =3
Bulletin #100 — February 19, 2020 Pagel of 2 kAH outs\Permit Application
MECHANICAL PERMIT
vain aR Ua++MAL WOW
Indicate how many of each Type of fixture to be installed relo
cated located - - -as part of this project, Do not
MENEENEEMEMEMbmAIR HANDLING UNITS FANS I GAS PIPE OUTLETS
include existing rixtures to remain.
OTHER (Describe)
AIR CONDMONER FIREPLACE INSERTS MOaQSta•••d•q
BOILERS FURNACES HOT WATER TANKS fow
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WODDSTOVES
PLUMBING PERMIT
indicate how many of each type of fixture to be installed or relocated as part of
BATHTUBS
DISHNASHERS
DRAINS
r
me
DRINKING FOVNTAINS
HOSE BIBBB
LAVS
RAINWATER SYSTEMS
SHOWERS
SVMPS
GENERAJL INFORMATION
CRII1GLMfA{ON DDnPF:rrM I WATER PVRVET01t
FlOaAloAf 1.0/\f
pptryNWREVIWi U!E
loz."'.�//i�/�iTtL
&to k- L4 asow a
It:r-1 I / -7
A A/
'this projoe ct. Do
Yrar� CTe
yAtMa* KUWnuNc: WOM
not include existing fixtures to remain•
URINALS
ACVUM BREAKERS
WATER HEATERS
WASHING MACHINES
s*jR puMUnR
1<,!5- 14,4 J/ C-w----A)
apSMO FlN SNNKLFA SYSTEM?
❑ yes ❑.�W
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
WATER PIPING
ti
OTHER (Describe)
TOTAL FIXTURES
of � Owtov��s
0 0
PRoposEo FRE surPREsNON sYsT 7
❑ Yes o kkr
Area - In occupancy Group(s) Construeflon # of
Square Feed —Type Stories
IL
lot
y - ; r M1 — .•rti LI .. r�r 1� 1i-� •1 r•a • k + -
I �
Y IL r
Y
Additional Information
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