09-102113ECEIVEA
PERMIT
Federal WayJUN 0 9 2Cu
COMMUMTY DEVELOPMENT SERVICES �lP I CAT I O N
253- 835 -2607• FAX 253- 835 -2609
www.1L o F FEDERAL A�
- / C) Z I
SF MF CO ME EL PL DE E!?
Bulletin #100 - 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
on cow►
SITE ADDRESS
3Z 3Ltio AJe S qf goo)
SUITE /UNIT # ZONING
ASSESSOR'S TAX/PARCEL #
NAME OF PROJECT
(Tenant or Homeowner Name)
"j- OTCvI/1 QCeA► J Tll,ot=3 -Er, EkPILF S SiJ� T�T�
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ELECTRICAL ❑ ENGINEERING IX FIRE PREVENTION
l<.E pktc,c VA IS TO STYIA 4E ONL-i W A ii-
HIS T JI
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME .
PRIMARY PHONE
PROPERTY OWNER
-90 9 ey)-N—
- $ I
MAILING ADDRESS, CITY, STATE, ZIP
EMAIL
PO 8 UX. 141 Z y F P CJiL w - l,-* 9 �
E] CONTRACTOR APPLICANT
PROJECT CONTACT
OWNER IS ALSO:
NAME
PRIMARY PHONE
5VS-TZ 13 wC-ST
(2s'3) 83�- I2-ga
�FME
NTRACTOR
MAILING ADDRESS, CITY, STATE, ZIP
FAX
r
z�46 �t0eJTA6G 0-0A0 VJ 3 c
(zi3 ) 7�,S - 0( 1
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
1n e
occoa('% -0o -aL.
NAME
PRIMARY PHONE
APPLICANT
( )
MAILING ADDRESS, CITY, STATE, ZIP
/ FAX
l ) -
PROJECT CONTACT
NAME
FfL,-\v`-) C o
PRIMARY PHONE
(z r3) -7 37 - 1
(Me individual to receive and
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
Lob r-vLC4�lTa4v np 0 ##.�. P,gCJP1(. WA.48041
(15-3,1 )833 - 12 q&
ALTERNATE CONTACT NAME:
PRIMARY PHONE
E-MAIL
C N A S
(Z 3))'33 - 12 -*5,3
Yila11J K PC r wLF Sir S t-nu PC-
PROJECT FINANCING
NAME
OWNER- FINANCED
Required for projects with
MAIIdG ADDRESS, CITY, STATE, ZIP
PRIMARY PHONE
value of $5,000 or more
(RCW 19.27.095)
! ) _
T
I cert(fy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fy that to the
best of my knowledge, the information submitted in support of this permit application is true and correct. I cert(fy 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 suc , which may be made by any person, including the undersigned, and flied against the
city, but only where such claim out of t reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t city as a t this pplication.
g
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 - 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
on cow►
I. k
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MECHANICAL FIXTURES
Value o Mechanical 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 existing f fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (Commemisi)
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
GENERAL
PLUMBING
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fbrlwes to remain.
BATHTUBS (or9ub /Shower Combo)
LAVS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS Wecmc)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL
INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
$ It 0 � �
NEW BUILDING
$
EXISTING /PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
... .... .... ...... ..... _ ..... ... ......... _. .................. _._.._ ...... _.. __...._ .......................... .............. ...._............................
BASEMENT
........... . ..... ........ _._........ _._.._ ...... .......................... _. ....... ....... ............ .... _. ............... _.._.__ ....................... _.
FIRST FLOOR (or Mobile Home)
SECONDFLOOR' ...._.._. .... _._.... ... _ .......... _ ................. ____. ........ ....... ..... .. ............ ___._.._._........__._..
.................... _..._._.__........... ................._...._._._..._ ._. ................ _._.... ...........
........._....
COVERED ENTRY
......................... . . . . . . .. . . . . . . . . . . ................. . . . . . . . . . . . . . . . . . . . . . . . . . . ................ . . ..... ............ ........ . . . . . . . . . . . . . . ........ . .... ........ ......... . . . . . . . . . . . . . . .
DECK
GARAGE ❑ CARPORT ❑
............................................................................................................................................ ...............................
OTHER (describe)
......._._... ................... ............ _......._._.._....._.._._.._._._._ ............. _............... .......... __.._,..........
Area Totals EXISTING PROPOSED TOTAL.
"NEW HOMES ONLY"
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW /ADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional, Information
NEW BUILDING
ADDITION
COMMERCIAL
- REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional, Information
TOTAL Bunanm
TENANT AREA ONLY
AREA ONLY
Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application