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15-101594 r ■ • L 1 ',-).fl ' CITY Of KIP Federal Way PERMIT F !RE1 CO ME PL DE E FP COMMUNITY DEVELOPMENT SERVICES APPLICATION r� , p.2 2 d 15 253-835-2607•FAX 253-835-2609 y • www.otmrredercthvatl.com 1 SIC 11 Bn mAgAOMIoy caws SUITE/UNIT# — QY1 MY)S PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# 2 DQ. DO , - — — — — TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING AFIRE PREVENTION NAME OF PROJECT N (Tenant Name/Homeowner Last Name) �1 Y.. Vv y S BUr'�s R-. }—�' ' PROJECT DESCRIPTION v`—�� v�� r lC \-e-r Y�G1 Detailed description of work to be included on this permit only NAME PRIMARY PHONE 4p/�/� ���+ �n�1 PROPERTY OWNER ` �`.Y`V�! L�'C'c'"A- / # C 0 MAILING ADDRESS E-MAIL CITY STATE ZIP 7NCOv.)-Y\_ -\c-� '�c \(y Tic. PHONE&Li g-1, 7(069 MAILING ADDRESS E_ , CONTRACTOR O 1 JX 12_112D C e crou)nf f cam 1i1V CY.e,P STATE OA ZIP L.FAX O<cZ, i-►ZS-qFsi-g(tiqs Wt1 SVTCONTRACTOR'S�ENSE#� L L4 i in DATE FEDERAL WAY BUSINESS LICENSE# NAME W•N`(r` (w'x'J,l• 1 PHONE irne. os (_ori eA r • APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX PROJECT CONTACT N y �S \C( o ,p� '. 1 / Cfb PxoNE (The individual to receive and J /A b 1/V )/`i, respond to all correspondence MAILING ADDRESS e //��� ^^ ����� p E MAD concerning this application) • CLi,/� YY' e (/5,-� �)0YE • CITY 4/�i \'C_.- STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME OWNER-FINANCED 0 Required value of$5,000 or more •. (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE 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 supplied to the city as a part of this application. SIGNATURE: . 4)01 _/ A ,/ r■/U�■ DATE 4-145- -f'J S PRINT NAME: {S 1Ut R '11'77 Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application • • • • �< c�,,,� °" ^, ,. R; .Ai day . ��, • " 'e'��..,a.,`�, ,,„ VALUE OF MECHANICAL WoRK $ �) I W. (a copy of bid or estimate must be provided) Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS 2_5- OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial) cr� �?Cir BOILERS FURNACES HOT WATER TANKS(cm) e0 COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES 8 7.; ',1 I)aas'j,' , s° 4414,1041t,,,,5 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(Elrcmo) 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? . yYes❑ No ❑Yes ❑ No r .IDE TIA� NEV k;QR D T-I„O }K .. ` AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT I FIRST FLOOR(or Mobile Home) SECOND FLOOR(, COVERED ENTRY • TECH GARAGE ❑ CARPORT ❑ ©THEi2(desctibe) <- EXISTING PROPOSED TOTAL Area Totals '-NEW7OMES ONLYa ESTIMATED SELLING PRICE$ #OF BEDROOMS • ".A. a ',a �� + a :411:117.414 „„ AREA DESCRIPTION Area Construction Group(s) Construction #of Additional Information in Square Feet Type Stories a :`a*NEW BUILDING _ ADDITION Yw �r ,} arc � 4.4,44 AREA DESCRIPTION Area rea Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories TOA BiTII DING' TENANT AREA ONLY • sy '"' i�,.� "�t43` PROJECTI REAONLY' Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application