10-100145RECEIVED
&Top PERMIT
Federal Way JAN Y 2
� E CATION
w = 5 9OF FED
IN
81Ti ADDRESS
ou-,-�4 3(v+ 5
SUITE /UNIT t
ZONING A88ESSOR'8 TAE /PARCEL e
330
9 S o - 00
NAME OF PROJECT
or Homeowner Name)
M L 5 Sol / S
(Tenant
u Qit/
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ]RE PREVENTION
/4C�- 41A-2Nt
PROJECT DESCRIPTION
-
Detailed description of work to
be included on this permit only
NA1Q:
PRIMARY PHONE
PROPERTY OWNER
V Mal.
KAMM ADDRESS, CITY, STATE, ZIP ! , `�
90 W "sr
E-MAIL
5 ;� 336 aez
OWNER I3 ALSO:
CONTRACTOR 0 APPLICANT PROJECT CONTACT
NAME
PRnfARY PHONE
4 JZ- /I�jAN S4ECc�2, 4- GE (-5 - -7Z /L
2 -3 bag- 1792
CONTRACTOR
MAIIJNG ADDRESS, CUT, STATE, ZIP
7/ ' WA 9e0�9(Z
P klL
FAX
3),636 038
D. So ,x 71 Syr
(ZS- -
WA STATE CONTRACTOR'S LICENSE i!
1 EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE f
MCA /, c'o z6--
103131 126,6
03-10 -y 00 (3L
NAME
PRIMARY PHONE
APPLICANT
�wM6 AS (f0 r1Z c-roR-
-
MAIIJNa ADDRESS, CITY, STATE, ZIP
FAX
PROJECT CONTACT
NAME
bAVt
PRnwLy PHONE
253 3O- ! 74 Z
(The individual to receive and
) 0/
respond to all Correspondence
concerning this application)
MAII.ING ADDRESS, CUT, STATE, ZIP
P ?� i 96 ay Z
FAX
K 7( ,,/A '
_
ALTERNATE CONTACT NAM&
PRIMARY PHONE
E-MAII.
S&-,:T AIA7V, 5
253 63$- -179Z-
PROJECT FINANCING
NAM
p oWtraR- FINANCED
Required for projects with
value of $5, 000 or more
MAHMIG ADDRESS, CITY, STATE, Z@
PROKARY PHONE
(RCW 19.27095)
I csrNVy under penalty Rf
perjury that I am the property owner or authorised agent of the property owner. I certVy that to the
best of my knowledge, the information submitted in support of this permit application is true and correct. I cer ft that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorised 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 ague 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, inchidtng the undersigned, and flied against the
city, but only when Amch claim
out of the reliance of the city, including its officers and employees, upon the accuracy of the
information the city
of this application.
SIGNATURE:
DATE Z,ort�
PRINT NAME- NpY I N
Bulletin # 100 — 4/17/2009
Page I of 4 k:\Handouts\Pennit Application
Value of Mechanical Work $ A COPY OF BID OR ESTIMATE MUST BE PROVIDED
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include eidstingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commercimo "
BOILERS FURNACES HOT WATER TANKS
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 ezistin fixtures to remain.
BATHTUBS (-- b/—comeO
LAVS W dS.*4
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (mcbm /wiry)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
Bulletin # 100 — 4/17/2009 Page 2 of 4 k:\Ilandouts\Permit Application