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16-100021 CITY of PERMI'II1APPLIC'AWELON Federal Way JAN 0 5 2016 PERMIT NUMBER c0 _ k. 0 0 oz ( _ FP CITY OF FEDERAL WAY _ _ `! _ _ TARGET DATE CDS SITE ADDRESS SUITE/UNIT# Iq Oo Sc,3 C< m 'QS VC 131d% 2 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 1,COo.. 00 z O( o 3 - 9 ! — TYPE OF PERMIT —❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT PAW LION- APAI2T44 P 2-- PROJECT DESCRIPTION QCi tr rin 4F,„ IG T() i--' c,Xl .::v. l Detailed description of work to Fo � be included on this permit only NAME �P^RIMARY PHONE PROPERTY OWNER i c'•` ,. -% `•1 qq --qg- SI©© MAILING ADDRESS E-MAIL CITY STATE ZIP 11005 NAME PHONE ,-„A0 A--t0 tr. S e∎" S `Iict,. 253--1` 1-1226 MAILING ADDRESS E-MAI CONTRACTOR `" — lake,ja??3 ?lac-. ` -t ic-1 Min MC�I40HNG4.�ut,S.654- ^ C STATr, ZIP FAX WA STATE CONTRACTOR'S LICENSE# EXPI TIOR DATE FEDERAL WAY BUSINESS LICENSE# iNNSrgi l��t �L � V G SI NAME PRIMARY PHONE `-5t1".. j.Q.,.— t -ZTo --7(q Q MAILING ADDRESS E-MAIL APPLICANT 1g0Z- Ia1C— TaiT5 Pki,-) /af #tc"7 mytt elA .tests -sk'f,.cc, CITY STATE ZIP FAX NAME PRIMARY PHONE U`��• PROJECT CONTACT MCCC L �e.v .ZS-5- SW- TA % (The individual to receive and `MAILING ADD S E-MAIL respond to all correspondence I-14°-• la °Z- 1e-MS 1'-W 'j' (C1( 1 t 7 t~�OJA'tcl "'S itt,,„ concerning this application) CITY STATE ZIP FAX NAME PROJECT FINANCING 0 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 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 information su•• . • . e '' • •art of this applicatio �f(►� SIGNATURE: `� ''"'`‘ /�----�_.�----"'.-., DATE ►n l.aC�: `-, PRINT NAME: i.. -/ '■S-Q." Bulletin#100-January 1,2013 Page 1 of 3 k:\I-Iandouts\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 SINK$(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 BASE*MENT% n r may, � �,.. FIRST FLOOR(or Mobile Home) SECOND i COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER(describe) EXISTING PROPOSED TOTAL Area Totals 1 EW BOMBS O1 L1 ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL—NEW/ADDITION AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories NEW BUILDING' /7;.,;( F,. ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories / .7 S✓ lf� d4/ //�'' it�/ TOTAL BUILDINC4 ; TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application