09-104581Soul
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CITY °F' PERMIT
Federal Way NOV 2 0 2009
COMA �.� DEVE�La0«PaM!«E,1V
T SERVICES
253 -835 -2 607• FAX 253- 835 -269 APPLICATION
CITY
OF FEDERAL WAY
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SF MF CO L PL DE EN FP
PROPERTY
SITE ADDRESF2,
SUITE /UNIT # ZONING ASSESSOR'S TAX /PARCEL # \
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PROJECT'
NAME OF PROJECT
(Tenant or Homeowner Name)
TYPE OF PERNIIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING NRE PREVENTION
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a"'aohad details -; „. PEOPLE
- OPERTY•OyWNSIt- — .-
NAME
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PRIMARY PHONE
( ) -
ING ADD SS, CITY, STATE, ZIP
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E-MAIL
CONTRACTOR APPLICANT C] PROJECT CONTACT
OWNER IS ALSO:
NAME aa11 � ,
ClIa^
PRIMARY P ONE
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MAILING ADDRESS, CITY, STATE, ZIP
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CONTRACTOR
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BTJSINESS LICENSE #
APPLICANT
NAMFF r
PRIMARY PHONE
MAILING ADDRESS, CITY, STATE, ZIP
( FAX
l )
PROJECT CONTACT
N
PRIMARY PHONE
(The individual to receive and
respond to all correspondence
concerning this application)
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MAILING ADDRESS, CITY, STATE, ZIP + Z�(7
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FAX
) _
ALTERNATE CONTACT NAME:
n �
PRIMARY PHONE
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E-MAIL
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PROJECT FINANCING
Required for projects with
NAME
�O
OWNER - FINANCED
MAILING ADDRESS. CITY, STATE, ZIP
PRIMARY PHONE.
) _
value of $5,000 or more
(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 defenseA such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claty0larises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ' y as art of this lication.
I
SIGNATURE: / DATE `
PRINT NAME:
Bulletin #100 - 4/21/2009+ age lof4 k:\Handouts\PermitApplication
211•t(�
VXN 1,C.00\I
RESIDENTIAI,
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
..................................................................................................................................... ...............................
BASEMENT
.......................................................................................................................................... ...............................
FIRST FLOOR (or Mobile Home)
...... ........ ..............................................................................................................._..... ,.......,.......,......,.......
SECOND FLOOR
.................................................................................................................... ...............................
COVERED ENTRY
............... .... .......... ........
DECK
................................................................................................................................................ ...............................
GARAGE ❑ CARPORT ❑
OTHER (describe)
........ ... ............._._........ ....... .... ,......... ..-.., ... ... ,....................... ... ,... ... .... ... ... . ... .... ,... ,... ,... .... ... ....... ,.,.
Area Totals EXISTING PROPOSED TOTAL
* *NEW HOMES ONLY"*
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
0 %J
COMMERCIAL - NEW/ADDITION
PLUMBING FIXTURES
MECHANICAL FIXTURES
BATHTUBS (or Tub /Shower Combos
LAVS (Hand Sinks) TOILETS WATER PIPING
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 fixtures to remain.
AIR HANDLING UNITS FANS
GAS PIPE OUTLETS OTHE (D cri
AIR CONDITIONER FIREPLACE INSERTS
HOODS (Commercial)
BOILERS FURNACES
HOT WATER TANKS (Gas
_
COMPRESSORS GAS LOG SETS
REFRIGERATION SYST
DUCTING GAS PIPING
WOODSTOVES
RESIDENTIAI,
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
..................................................................................................................................... ...............................
BASEMENT
.......................................................................................................................................... ...............................
FIRST FLOOR (or Mobile Home)
...... ........ ..............................................................................................................._..... ,.......,.......,......,.......
SECOND FLOOR
.................................................................................................................... ...............................
COVERED ENTRY
............... .... .......... ........
DECK
................................................................................................................................................ ...............................
GARAGE ❑ CARPORT ❑
OTHER (describe)
........ ... ............._._........ ....... .... ,......... ..-.., ... ... ,....................... ... ,... ... .... ... ... . ... .... ,... ,... ,... .... ... ....... ,.,.
Area Totals EXISTING PROPOSED TOTAL
* *NEW HOMES ONLY"*
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
0 %J
COMMERCIAL - NEW/ADDITION
PLUMBING FIXTURES
Indicate number of each type of fixture to be installed or relocated as part roject. Do not include existing fixtures to remain.
BATHTUBS (or Tub /Shower Combos
LAVS (Hand Sinks) TOILETS WATER PIPING
DISHWASHERS
RAINNW STEMS URINALS OTHER (Describe)
DRAINS
HOB WERS, VACUUM BREAKERS
DRINKING FOUNT
SINKS (Kitchen /Utility) WATER HEATERS (Electric)
HOSE BI S
SUMPS WASHING MACHINES TOTAL FIXTURES
ADDITION
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
Area
in Square Feet
Occupancy Group(s)
Construction
# of
Stories
EXISTING /PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAI,
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
..................................................................................................................................... ...............................
BASEMENT
.......................................................................................................................................... ...............................
FIRST FLOOR (or Mobile Home)
...... ........ ..............................................................................................................._..... ,.......,.......,......,.......
SECOND FLOOR
.................................................................................................................... ...............................
COVERED ENTRY
............... .... .......... ........
DECK
................................................................................................................................................ ...............................
GARAGE ❑ CARPORT ❑
OTHER (describe)
........ ... ............._._........ ....... .... ,......... ..-.., ... ... ,....................... ... ,... ... .... ... ... . ... .... ,... ,... ,... .... ... ....... ,.,.
Area Totals EXISTING PROPOSED TOTAL
* *NEW HOMES ONLY"*
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
0 %J
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEUTENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Occupancy Group(s)
Construction
# of
Stories
Additional Information
TOTAL BUDDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts \Permit Application