16-100020 •
CITY of
PERMIT!PPLICATION
Federal Way RECEIVED
1 ( _ 1, 00 0 70 _ cp JAN 052016
PERMIT NUMBER l� 0
_ _ _ ! TARGET DATE �^��
SITE ADDRESS SUITE/
ici oo S. )- 151.01. 20
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ ,OCC, CC [ 3 zC o. _ 9 lv'3
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ENGINEERING°FIRE PREVENTION
NAME OF PROJECT .V t L Q - / „i ,rj1S1
PROJECT DESCRIPTION ! ,1eve\ an :�E i0 TO C)-XtS %
Detailed description of work to ACZP,,
be included on this permit only
W0%) ■ i . .A _C- 2n h.a wi
NAME PRIMARY PHONE
PROPERTY OWNER Cj `A-• gel??elf? --jq S-0
MAILING ADDRESS E-MAIL
q C, 'W CO-v� ,}S ` �, tLt��l'TC.Ai 1'&I.Ccv..,
CITY STATE ZIP
PHONE
yInel0∎, 1 0t, k 5 iii.. is--- --43q t-l2zC
MAILING ADDRESS - E'
C`L a k f "s fkw 5k k lcY1 'Ft1�17 lone i , .wicu^„kuz,S ike,s- .(0
CONTRACTOR � � � �'..�-- ��` ��
C STAT ZIP FAX
� � `' 1 z
WA STATE CONTRACTOR'S LICENSE# EXPIRAINN DATE FEDERAL WAY BUSINESS LICENSE#
NAM - -- PRIMARY PHONE
E► `p 1^S�c v,--z. "--0 --7 rci<'
APPLICANT MAILING ADDRESS -c,-).1 t” E-MAIL
tcf Ltc_i , 3 sPk�)5 - to - #t4'7 n.. : twc.#. 0 S wS4aC'I,:Go•
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT 1"iC,t+, -. \ --S e-A/■- 4 } 36ga
MAILING ADD S E-MAIL
respond individual to receive and 1 1a I r r� {i,M, %- j` t i jr/•7 t-
respond to all correspondence 1 �. Y� `1 „..4C = 2.1'�ltf dLkir
concerning this application) CITY A STATE ZIP FAX
H CA- C-A LJ fr4 .5C561 z
NAME X OWNER-FINANCED
PROJECT FINANCING
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 et"I •. • •art of this application
SIGNATURE:. ,.......e---: i DATE tru.x.� �) !wu(
PRINT NAME: - L Z;vr\ .��
.ter
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Pennit 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(ca.)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING _ GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type offixture 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(Elecoic)
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 Fir0032 °"''
COVERED ENTRY
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
in Square Feet Type Stories
- NEW BUILDING cv
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING < f p f�
t
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application