16-100828 1
�,>~oF ICEIVED PERMITeiPPLICATION
Federal Way FEB 162°16
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PERMIT NUMBER
TARGET DATE
SITE ADDRESS jr1-- SUITE/UNIT•
A r 54
PROJE ti ZONING ASSESSOR'S TAX/PARCEL•
$
411 WVa D '5 '.' i 0 9 1 z 3
OF ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING MIRE PREVENTION
NAME OF PROJECT ^
eC'7' -
Detailed description of work to r .111 .._ N3 i ... __...
be included on this permit only \ '
1 NAME 111P1 —PROPERTY OWNER `" _,I. JI t ( C.,0 L i t � ; • ^�4I • /V
MAILING ADDR'=S
(090 s Ne,il rnc, S4
CITY STATE ZIP I
'C
4214-C. C1-114
NAME PHONE
1 7-1 Vi,-Shrt1 :==
MAILING ADDRESS'7
CONTRACTOR ? 0 0x. 2-3%1 • awl
CITY STATE ZIP FAX
( tf AA-i2Or -,,,,I. Q S- 527.
WA STATE CONTRACT^D'A LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 0
F e a *. r u c- / / 3U / / ,
J�---
NAME 1 s�NE _ ® 3 V
APPLICANT ADDRESS 4 ,n~\1 E-MAIL r7•^Ir',`(J�
4 'I 0 - fr2- _A*.
.._ lin 20 L__7ffi1•liff FAX
N
PROJECT CONTACT R F j :T �► Y 1&1z j' PRIMARY
'7-53-311 (j Z 3 7
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP 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 environm ntal laws.
I further agree to ld less the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation a % def of such claim), which may be made by any person,including the undersigned,and filed against the city,
but only where h claim • -ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supp ed to the -ity as , part ,f this •p,lication.
�I 1
SIGNATURE: 't`1'! .A - 6 I DATE 2 I W 4 to
PRINT NAME: !IV'wi�
l O Ale
Bulletin#100—January 4,2016 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many 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(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how many 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(Kitchen/utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
—
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
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)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING(-
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 4,2016 Page 2 of 3 k:\Handouts\Permit Application •