09-101841CITY OF 44Y.1 9ERMIT
Fed
COMMUNITY 253-835-2607- ` DEVELOPMENT
25 8 5E2 o E t APPLICATION
�-v(IN - !I.
�� - l i
SF MF CO ME EL PL DE EN P
SITE ADDRESS C
,3-Zc,-,O 1
SUITE /UNIT # ZONING ASSESSOR'S TAR /PARCEL #
q0b I -L (,o— --L c c �t-- 9-O O
NAME OF PROJECT _
(Tenant or Homeowner Name) G15S) V S V4Lf C-
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ELECTRICAL ❑ ENGINEERINGXFIRE PREVENTION
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
1:-\ (1 V
NAME PRIMARY PHONE
PROPERTY OWNER p��J W �j L(lS3 ,
MAILING ADDRESS. CITY, STATE, ZIP E -MAIL.
OWNER IS ALSO:
CONTRACTOR ❑ APPLICANT PROJECT CONTACT
NAME
PRIMARY PHONE
CONTRAC R
061
MAILING ADDRESS, CITY, STATE, ZIP
,)L1-2_D. n1
FAX
p2S31l35 -013
WA STATE CONTRACTOR' LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
'in.ia Sv= - -�
/ 16 /I I
1i -g')- of -1 -co 1?`
APPLICANT
NAME
/'' �C�I�Ptj
PRIMARY PHONE
(213 )pS3
MAILING ADDRESS, CITY, STATE, ZIP
FAX
2-15 Fnm,wi 6c
o,, Ii
PROJECT CONTACT
(The individual to receive and
NAME
�:—n^NC. 0
PRIMARY PHONE
(x.53 ) ) - R-4
MAILING ADDRESS, CITY, STATE, ZIP
• ,F , N
FAX
(2S 3 )-)35'-,b 1) 3
respond to all correspondence
concerning this application)
ALTERNATE CONTACT AME:
PRIMARY PRONE
( l _
E -MAIL
PROJECT FINANCING
NAME
OWNER- FINANCED
Required for projects with
value of $5, 000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PRIMARY PHONE
(RCW 19.27.095)
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 true and correct. I certify 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 such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim aril out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied rl' a�par f this application.
SIGNATURE:
PRINT
P t-'Ntci--4
DATE -C— I 1q / O 5
Bulletin #100 — 4/21/2009 Page I of 4 k:\Handouts\Permit Application
0
COMMERCIAL
MECHANICAL FIXTURES
Value of 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 fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (commere all
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
COMMERCIAL
PLUMBING FIXTURES
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 /Shower Combo) LAVS (Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS 00tncrn /U(J1jty) WATER HEATERS (Ekrtrir)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
Occupancy Group(s)
Construction
Type
# of
Stories
GENERAL
INFORMATION
PROJECT // VALUATION /.
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXIS G /PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes ❑ No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
RESIDENTIAL
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL.
FOR OFFICE USE
............................................................................................................. ...............................
BASEMENT
.................. .. ........ ..... _ .... ............ .. ............ -- ............ _. .......... -- ............ ._ .......... ,...... .
FIRST FLOOR (or Mobile Home)
........... .................. ... .... ..... ... ....... ..... ... .. ............................ ....... ._......... ....... _ ........... ............ .._ ........... ........_ .... .. .... ....
SECOND FLOOR'
..... ....................... ....._........ _._... . . _
COVERED ENTRY
.............................................................................. ............................... ..................... ...............................
DECK
GARAGE ❑ CARPORT ❑
..... ... ........ .... .................. ............................. ....._ ............. _ ............... ...... .... ... _ ..1...1...1.1..................
OTHER (describe)
.............. 1 111 ............ ...... ..... ... ... ... __. _. .._....._.._ .. ...
Area Totals
EBISMG
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 Grou
Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application