10-102055WERMIT
Federal t'
C0M WM1YDEV=PAW oo LIGATION
253- B3s2607• PAX 253-8352609 APPLICATION
U�a,a��ay �P�
SF CO ME EL PL DE EN FP
SIT!'. ADDRESS C151: v-
FAX
NAME
ZONING ASSESSOR'S TAX /PARCEL #
2
SUM/UNIT #
5Q
—q
NAME OF PROJECT
' /� 61d
Y'Q �%
! t C,
NAME A-
(Tenant or Homeoumer Name )
13" G I
❑ BUILDING ❑ PLUMBING
❑ MECHANICAL
PRIBLUM PHONE
TYPE OF PERMIT
❑ DEMOLITION 19 ELECTRICAL
❑ ENGINEERING lj FIRE PREVENTION
erian+ Sm rDve-men+ -I-v , r
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PROJECT DESCRIPTION
Id ,
Detailed description of work to
be included on this permit only
PROPERTY OWNER
OWNER IS ALSO:
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
Required for projects with
value of $5,000 or more
(RCW 19.27.095)
RAM
0,- , Prvpe•- f ; e S
=ILING ADDRESS, CITY, STATE, ZIP
-L 6
PRDtARY PHONE
i ) -
E.N(AiL
CONTRACTOR 0 APPLICANT PROJECT CONTACT
NAME PRU ART PHONE
ai2.id�
ian ,Sect,il �Ele� rd � c 3 8 FAX .2
p �,, WA- ((? / /-, FAX/ / /�,
MAILING ADDRESS, CITY, SPATE. ZIP , `e + • 90 / //"— i► - V K!
WA STATE CONTRACTOR'S LICENSE 4 EXPEtATION DATE. FEDERAL W °9 RISDIESS LICENSE #
U3 /v?�j /�- Ob-IaS "Gb BL-
PRIMARY PHONE
NAME 1--
Qn
WAILING ADDRESS. CrPY, STATE. ZIP
FAX
NAME
PRIDfARY PHONE
1 7f;7-
(25-363
MAILING ADDRESS, CITY, STATE, ZIP
FAX
ALTERNATE CONTACT NOME: PRIMARY PHONE
Skm 2Jei11 m0 �� -
E -MAIL
ca ✓ /j�
NAME A-
OWNER- FINANCED
MAMING ADDRESS, CITY, STATE. ZIP
PRIBLUM PHONE
r 1 _
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 tress and correct. i certify that I will comply
with 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 frderal laws regulating
construction or environmental laws• and attorneys' fees incurred
I further agree to hold harmless the City of Federal Wag as to any claim (includin9lr is �� ° 11 ° the
in the investigation and defense of such claW, which may be made by any Person, o the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy f
information supplied to the city as a part of this application.
SIGNATURE.
PRINT NAME: %� �D Y�'�•r" r1� �
Page I of 4 k:\i-Tandouts�Pernlit Application
Bulletin #100 - 4/17/2009
t
Value o Mechardcal Work $ A COPY OF BID OR ESTIMATE MUST BE PROVIDED
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include e.)dstingfixturesto remain_
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commaa.q
BOILERS FURNACES HOT WATER TANKS (c.*
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fvdures to remain.
BATHTUBS (wT,b /ffl rC mbo)
LAVS MandSUAO
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Descn'be)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (tch— /utility)
WATER HEATERS (Ekvbia)
HOSE BIBBS
SUMPS
WASHING MACHINES '
t,
.71
PROJECT VALIIATION
a WATER PURVEYOR SEWER PURVEYOR VAL= OF E7QS MG MWROVZMMTS
L.R�A
LOT SIZE an Square Feet) - - E7 MMIG FIRE SPRIIiRLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
Bulletin #100 —4/17/2009 Page 2 of 4 k:lHandouts\Permit Application