22-102133-Permit Application-5-9-224ik
CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8w Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenteracityoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT i
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL N
$ ISO 000
R S 9. G
3 1 S 1 G 0-
0 1 S 5
TYPE OF PERMIT
KBUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
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gome WA
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
CA) i bw �-S-��`�on �It1� gidlz; l
PRIMARY PHONE
L�3 - 3;3 Z - 29 13
PROPERTY OWNER
MAILTUC& AnnRESS
2iC) S '3601i ST
E-XAIL
CfILi 6eSO- 4) CztMAiL.
CITY STATE
i ederA-L u0R
ZIP
j/8003
(WA
NAME
C.�� ib �.2S'�'2t•! a-� o� �`� `
PHONE
ZS 3 - 332— 2C1 13.
MAILING ADDRESS l�.�
27p 1 S 3�Q ` �}
E-XAM
CFt0 W_ meaH �1..
CONTRACTOR
CITY
jL w"a
STATE
A
ZIP
92003
FAX
WA STATE CONTRACTOR'S LICENS1r#
CZ �:. >, i � 1--
EXPIRATION DATE
VD � � / zc 2 z
UBI 8
6 0 4 -Lt''S3 - g S 1
NAME
PLMARY PHONE
MAILING ADDRESS
ILA M is \AJ r In
E-MAIL
Phv e L 2 tR av e L� 4
APPLICANT
CITY
P,
I STATE I
tk/A
ZIP _
°l
FAR
NAME QQ
A�� �;-S � I t G1iV1+
PRIMARY PHONE
PROJECT CONTACT
J
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
FAX
concerning this application)
PROJECT FINANCING
`ZIP' r`
NAME W i ber R-9S-OCAA'-OV) I--�
121 OWNER -FINANCED
When value is $5, 000 or more
(RCW19.27.095)
MAILING /ADDRESS, CITY, /ST�A�TE``, tZIIP (''' � A � ,{�
FL`7V k S �; �'V i'` J+ �CAe-C&I VV (-1
^ PHONE
2. S3lcI �
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 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 of this application.
SIGNATURE:
/+
DATE 5 `a Zo 2-
L�
PRINT NAME: it
CH
:IVVI
:0VV 1
Bulletin #100 - February 19, 2020 Pagel of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT Is SOoO
Indicate how many of each tjilpe of fixture to be installed or relocated as part of this project. Do not include existigg ftxtures to remain.
AIR HANDLING UNITS_ FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER Z FIREPLACE INSERTS HOODS (commercial)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT
VALUE OF PLUMBING WORK
$ Lf00o
Indicate how many of each type of ftxture to be installed or relocated as part of this project. Do not include existin tares to remain.
BATHTUBS (or Tub/Shower-Combo) �_ LAVS )Hand Sinks)— TOILETS
DISHWASHERS RAINWATER SYSTEMS URINALS
DRAINS 2 SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS _� SINKS (Gtchen/Utihty) WATER HEATERS (Electric)
HOSE BIBBS SUMPS I WASHING MACHINES
WATER PIPING
OTHER (Describe)
I G
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
No
WATER PURVEYOR
Lakes IAvev, d er
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
vl� VhZ
LOT SIZE IIa Square Feet)
I Cl y 9 U
EXISTING FIRE SPRINKLER SYSTEM?
❑ YesK No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes Ai No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
....................................
..........................................--......------..........
FIRST FLOOR (or Mobile Home)
......... __-_—_-_
......................... -_...... ..-- ........ -........................
SECOND FLOOR
COVERF,n ENTRY
....... -.............. -.......
-.___ .......... _._____.__....
---....... -............ --... --... _..__...... .......... ---._...-- -
DECK
......... ------ .....-------------
---------
GARAGE ❑ CARPORT ❑
...-----. ... _
_ _ _ .._...-- -... - ....... -._............
OTHER (describe)
.. ...------.....
-..._.-_........ --.......
Area Totals
EXISTING
PROPOSED
TOTAL
...... -...._....... __.....
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s) s
P Y P()
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s) s
P Y P1 1
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AI�I;A ONLY
PROJECT AREA ONLY
Bulletin #100 - February 19, 2020 Page 2 of kAllandoutsTermit Application