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09-102772
#f Fe -,-, EIVEM PERMIT C0"UMTYDEV&LOFMSNT SBRVICW APPLICATION ass- sssaeo�• FAX 253. 835-26 .a "v.,. 1 L, 2 2 2 G0 9 SF MF CO ME EL PL DE EN FP r� NAME OF PROJECT (Tenant or Homeoumer Name) ' BUILDING ❑ PLUMBING ❑ MECHANICAL TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION PROJECT DESCRIPTION D Detailed description of work to be included on this permit only /') /1 g 1211 ?' l7 .(� (R� //1f -7-A )Ci�) P-1m, ,:Al TD AW j6L-rl) / /r' - Vii D 7L117i, NAIL _ PRD/ARY PHONE PROPERTY OWNER NAM= ADD , CITY, STATE, AP E-NAR. R 5 &v , , ar.L�� mp l OWNER IS ALSO: COWRACTOR AMICMft 0 PROJECT CONTACT NAME PRDIARY PHONE CONTRACTOR MADamo ADDREss, crrY, stgffiz, zip FAX -T WA STATE CONTRACTOR'S LICENSE N IMPIRATION DATE FEDERAL WAY NUSINEW LICENSE i NAME PRDeARY PHONE APPLICANT S - MAMM ADDRESS, CITY, STATE, ZIP FAX PROJECT CONTACT NAME PRDl1ARY PHONE (The individual to receive and A6 ©U- %U respond to all correspondence M UNG ADDRESS, CITY, STATE, ZIP FAX concerning this application) _ ALTERNATE CONTACT NAME: PRIMARY PHONE E -MAD. PROJECT FINANCING NAM OWNER- FINANCED Required for projects with value of $5, 000 or more MAnmu; AxFb7,crft, STATE, zw PRIMARY PHONE #RCW 19.27.095) l 1 I certVy under penalty of perjury that I am the property owner or authorized 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 certVy 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 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 citg, but only where ch claim arises out of the reliance of the city, inc its q�icers and employees, upon the accuracy of the information supplied the city as a part of this application. BIGN DATE // PRINT N"'CS•• ft;�- r lac r ) �4 AJ Ai t ��l AJ � r Bulletin # 100 — 4/17/2009 Page 1 of 4 k:\Handouts\Permit Application MCI 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 eidstingfixturestoremairL AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (commweiai) 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 existing fixtures to remain. BATHTUBS (or Tub /Sbowercombo) LAVS (HaedSb*o TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS (Kia>c�/uauiW WATER HEATERS (Electric) HOSE BIBBS SUMPS WASHING MACHINES 'FEA!!llt G��, PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVENUU B E7aSTUM /PREVIOUS USE I LOT SIZE (In Sgw:e Feet) I MU"ING FIRE e13MR NLER SYSTEM[? I P❑RYPOSEI3 FIRE SUPPRESSION SYSTEM? Bulletin #100 — 4/17/2009 Page 2 of 4 k:\Handouts\Permit Application