23-101109-Application-06.06.23PERMIT APP
CITY OF ��•LICATION
PER
Federal Way MIT CENTER + 33323 bA n A�cuc South + Fedcrul Way. WA 98003 G325
253 835 2607 + F.LK 2S3 835 2609 + permitcerltcr <It}'ollcdcrrllw,.y com
PERmrr NUNDCR a 3 _ o _� 1 O •, S TARGET DATE
SITE ADDRESS ISUITE/UruT e
PROJECT VALUATION ZONINU ASSLUSOR 8 TAX/PARCEL e
$ as �L _L _a- V_ V_ - o_ 6_
TYPE OF PERMIT
Eat itnl� , O R.o ❑ NISUA%ICAL O DEmarn •i ❑ EN01yFFR11,ri O FIRi, PkF-',1.%T0'+
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed dcscnpteon of Ivork to
be vlcluded 0,1 thus per-Mit only
PRINART PHONE
JAME
r ,
1Clio R Carr-LOPSP-a f ?R1
1253
PROPERTY OWNER
idMLINO ADDRL33
st
L NAIL`
I
CITY
A
ZIP
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W
NAIL
PIIONL
►WUNo ADDRESS � �/ p
aA� I -I fh
I S�
E-NAIL
S%a -7 lr r"� re'
CONTRACTOR
1
FAX
«Y RTA E Z o a
UDI 0
WA STATE CONTRACTOR'S LICL.YBE 0 EXPIRATION DATE
/ U /Pois
AoY1
NAME '�
PRIMARYP110NE
"Ice
5 Z9 7__M3 -3.
NAILING ADDR£ s 5 kr-
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Car
APPLICANT
FAX
C(Tx_
r
TATL Z1
Sao
NAME !
PRIMART PHONE
'a
PROJECT CONTACT
/ /l!� �f
[AILING ADDRESS
1 Sf 1�22-
E-MAIL
C P i
rAe utdtwdual to rcceme and
respond to all Correspondence
CITY /�
STATE
zip
FAX
concerning this application)
C �Q G
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
11 hrn value is 55 000 or more
NAILING ADDRESB, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorised 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 urill comply with
all applicable City of rederal 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 whore 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.
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SIGNATURE: CN DATE V 1V - 0,0
PRINT NAME:
L_
I
7
Bu11mn g 100 - February 19, 2020 Pagc I of 2 k \I landoutsTennit Application
NILCIIA,NICAL PEILNIIT $
Indicate how man 0 rr1C1, 11 pr n u •.r, to to L^S�i2 �C I Pr rf'xwcd a-:iGrt of I L .roNYr Do ncI we-'.1de eiw:tin �Lzf!jrC3 1� ►E'^Llrt
AIR IIANDU`rG 1;%IIS MS CAS PIPE OtTL6'-`J OT14FR IDrun'-cl
AIR CONDIT 6t;ER F;P.EiucE ItiSERTS 1;000S,c —. -.4 __ a
DOILEP3 r'LR`+ACLS HOTWATERTANKS—
CONIPRFSSORS GAS L.Or, SETS F=FRIGEQAI,Oti S1ST
DL'CTP.O GAS F TING u GODSTG%'FS
VALUE OF FYc }Jr.:r � WpRY
PLUMBING PERMIT
$
Indwire how many orench totupom
of Ixt1,►c ro be 1tsrallyd or n-i
part of Nis proycl De not include crsrino Ttur(,9 to ►cma,rt
EIATIITL'DS
LA),31vWA
TOILETS
"'ATERIiF1%G
DISH'J.ASHER3
RAINWATER S1 STEM9
L'F)\•VS
OTIIER Mevrilr_I
DRAINS
SHUti,ERS
VACuLfM DRF-ARER3
DRISMS0 FOU\TANS
SI%KS
WATER HcL1TEnS (r.rn
HOSF. DIM35
SL'MM
WA.S11.%G MACHINES
TOTAL FWrURES
CENERU. I\FOILMATION
CRITICAL AREAS OR PROPERTY?
WATER PURVEYOR
SEWER rURVETOR
VALUE OF QJtM %V IMPROVEMENTS
E3ISTTNO/rRE1'IOUs USE
LOT SIZE tla Square Peet)
zmSTI]G FIRt spRIRKLEt svvEMT
rROrosro r RE SUPPRESSION SYSTEM?
iJ Yes C No
C Yes C ,No
RESIDE\TIAL - NENVOR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Nome)
SECOND FLOOR
COVERED EA►RY
DECK
GARAGE ❑ CARPORT ❑
OTHER feescru-ti
Area Totals
LZ3ST O
MPO=
TOTAL
•'hEN NOkffi.S OhZY" •
ESTIMATED SELL]\G PRICES
tl OF BEDROOMS
CO:NIAIERCUL — NEWA.DDITION
AREA DESCRIPTION
Area in
S uare Feet
Occupancy Group(s)
Construction
Type
1 of
Stories
Additional Information
NEW BUILDING
ADDITION
COINIMERCIAL — REINIODEUTENAINT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(.)
Construction
a
of
Stories
Additional Information
tuaAL BUMDING
TENANT AREA ONLY
P&oJLCT ARF.% ONLY
Bulletin A100 — February 19, 2020 Pave 2 of 2 k. Ilandouis crinit Application