16-100019 0
PERMITITION
n]�D
RECE_ JAN 05 20 16
_ l v 0 0 t _ TARGET DATE CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT if
1900 Sc C nc's Dr, 131C f - 15.--
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# /1
$ 4cccioc 13 1 (0 3 _ C CD
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT /- F-�D -FA
PROJECT DESCRIPTION �pIG ,et 0) I" v1 •' E f, Ic1 to .� p-XlSil`,.%
Detailed description of work to I'"ftl..'°P; J
be included on this permit only
.V t 1 ro es- A- ' wt v.t- levwe e,5
NAME�� PRIMARY PHONE
PROPERTY OWNER 1 1t.\0- C(L/C _?JC _ S"C3L
MAILING ADDRESS `E�- %. ( d
ICI OC bv3 Ca.v ,: ,A ,ue., ` its ',o,i+- 1 •l4',,
CITY STATE ZIP
NAME,••,,..,
PHONE
MAILING ADDRESS E"
CONTRACTOR 1 ciC;L kt.kt-Far �> ks...i �. 54---)t,01 447 A1C�i Nno°r4 tf-,?Isi-zn^i i�Qv .
C,,F77.¢T7,;4��}; STATF� �ZIIP FAX
NOV }
WA IN 1 yJ CONTRACTOR'S
l 1 / �( c)(LICENSE# EXPIRA ! 4� �
LICENSE#
1
NAME PRIMARY PHONE
Pm,a , ' ,;, `,-yet, S 4.s..-. Zsi -22o a-'t lq Q
MAILING ADDRESS E-MAIL
APPLICANT '
r
CITY STATE ZIP FAX
.
NAME - - PRRIIMMA.R.Y PHONE
PROJECT CONTACT M(;t+l VvS€__ •- ZJ - -0
The individual to receive and MAILING ADD S E-MAIL
&' S
respond to all correspondence t`-104.- 16L4- - T , 6 Ski, (d 1 7
I'^'^C '` it lii-ei-stickur-
concerning this application) CITY STATE ZIP FAX
H i.,bu<--n GO(.1 CI CM Z -
PROJECT FINANCING NAME J2,-OWNER-FINANCED
Required value of$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 Iocal, state, or federal laws regulating
construction or environmental laws.
1 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
information su•• • • c:`• ••. • •art of this application
SIGNATURE: I �.__._...._ DATE vIon.; `Jj [.�-'�ic�
PRINT NAME: . 4 ZA.4) "
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
a •
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(Comorer ai)
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/utitity) WATER HEATERS(El...a)
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 <1
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describbe)
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction
A of Additional Information
in Square Feet Type Stories
N w BUILDINQ' hls ,
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction *of Additional Information
in Square Feet Type Stories _
TOTAL'BUILDING { .{
TENANT AREA ONLY
PROJECT AREA:ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Penmit Application