23-101832-SF-4-12_23-Building permit application-04.12.23CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8fl, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permiteenterCucitcoffederal%va%.com
— -- — W TARGET DATE
SITE ADDRESS
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SUITE/UNIT ti
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PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL S
a4,114, S-3
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TYPE OF PERMIT
A((�$UJLDING ❑ PLUMRING ❑ M1iCI3ANC ❑ DRRE; I'R MOUTION ❑ ENGINrwRING ❑ FIRE;
NAME OF PROJECT
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PROJECT DESCRIPTION
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Detailed description of work to
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be included on this permit only
NAME
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PRIMARY PHONE
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PROPERTY OWNER
MAILING ADDRESS
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E-MAIL l
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CITY
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PHONE
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MAILING ADDRESS �j
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CONTRACTOR
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STATE
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FAX
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WA STATE CONTRACTOR'S LICENSE M
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EXPIRATION DATE
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NAME
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PRIMARY PHONE
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MAILING ADDRESS
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APPLICANT
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NAME pp p I 1
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PRIMARY PHONE
PROJECT CONTACT
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(The individual to receive and
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respond to all correspondence
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concerning this application)
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PROJECT FINANCING
NAME
OWNER -FINANCED
When vnlue is $5, 000 or fhore
(uclV 19 27 09s)
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 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 artof this if tion
SIGNATURE: DATE 411,1,
PRINT NAME: r D
Bulletin # 100 - I"ebniafy 19, 2020 Page 1 oC 2 kAHandoutslPcnnit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type o e to be installed or relocated as part of this project. Do not include existingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (com mig
BOILERS FURNACES HOT WATER TANKS (rm)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OFPLUMBING WORK
PLUMBING PERMIT
Indicate how nuiny o each type of fbdure to be installed or relocated as part of this project. Do not include e;dstingfixtures to remaim
BATHTUBS (orTnb/shau combo) LAYS (H.dsinnm) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitaben/unthy) WATER HEATERS (etcw;c)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FLWMRES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF I«TISIIMi IMPROVEMENTS
/ vO
$
EXI3'1WG/PREVIOUS USE
LOT SIZE (In Sqm— Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Ie ;� I
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (orMobde Home)
SECOND FLOOR
COVERED ENTRY
DECK
160
309
3 0 9-
--- -----•------ --------
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
9111=71NO
P=p0sw-
**MW HOMRS
ONLY**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODELITENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BuumiNG
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin # 100 - February 19, 2020 Page 2 of 2 kAHandoutslPermit Application