10-104702c1TTQ,ARECE'\_#.D
Federal way PERMIT
C253.635 -2607- FAX 253 -835 -2609 OMMUNrfP DEVELOPMENT SERVICES O O p CAT I O N
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SITE ADDRESS U L.
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SUITE /UNIT A
720 S. 348th A -1 B Federal Way Wa. 98003
PROJECT VALUATION
$ 1,300.00
ZONING
ASSESSOR'S TAX /PARCEL #
2, 3 9 j_ CC) l 0
TYPE OF PERMIT
E3 BUILDING ® PLUMBING Q MECHANICAL
DEMOLITION r3 ENGINEERING F1 FIRE PREVENTION
NAME OF PROJECT
rfenant Name /Homeoumer Last Name)
Kuzminskiy Communications
PROJECT DESCRIPTION
Detailed description of work to
Install 2 strobe only ceiling mount device and 1 conventional heat detector in new
bathrooms
be included on tits permit only
NAME
PRDAARY PHONE
PROPERTY OWNER
Yako Liu DDS
MADdNG ADDRESS
720 S. 348th St Unit A -1A
E-MAIL
CITY
Federal Way
STATE
WA
ZIP
98003
NAME
FSI Confidence Plus Inc.
PHONE
CONTRACTOR
MAILING ADDRESS
1524 45th st. East #102
E-MAIL
CITY
Sumner
STATE
Wa.
ZIP
98390
FAX
WA STATE CONTRACTOR'S LICENSE #
FSICOCP918Q4
EXPIRATION DATE
1 24 X2011
FEDERAL WAY BUSINESS LICENSE #
20 -09- 104923 -00 -BL
NAME
Chase Clements
PHONE
253 - 561 -1202
APPLICANT
MAILING ADDRESS
1524 45th St a #102
E -MAIL
chase @fsicpi.com
Cam'
Sumner
STATE
A.
ZIP
98390
FAX
PROJECT CONTACT
(The individual to receive and
NAME
Same as Above
PHONE
MAILING ADDRESS
E-MAIL
respond to all correspondence
concerning this application)
CITY
STATE
ZIP
FAX
ALTERNATE CONTACT NAME:
PHONE
E -MAD.
PROJECT FINANCING
Required value of $5.000 or more
NAME
OWNER FINANCED
MAILING ADDRESS. CITY, STATE. ZIP
PHONE
(RCW 19.27.095)
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 igformation 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 such claim), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
Wormation supplied to the city as a part of this application.
SIGNATURE: _... ATE poi d
PRINT NAME:
Bulletin #100 -April 14, 2010 Page 1 of 3 k:\Handouts\Permit Application
.A 1
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how marry of each type of fixture xture to be installed or relocated as part of this project. Do not include extsting,fUtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (com —ciaq 4 . L 0 WIC ww
BOILERS FURNACES HOT WATER TANKS )Gaa) DeLi Zel_,S
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing flYtures to remain.
BATHTUBS )or fhb /shower Combo)
LAVS )Hand sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS MWhen /Utwty)
WATER HEATERS (E- -bic)
HOSE BIBBS
SUMPS
WASHING MACHINES
a 9J lTKif�$;
CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR
EXISTING /PREVIOUS USE
SEWER PURVEYOR ) VALUE OF EXISTING IMPROVEMENTS
LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? I PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
Bulletin #100 - April 14, 2010 Page 2 of 3 k:\Handouts\Permit Application