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10-102489 INtrseE • Federal 1a PERMIT ✓ M C• �0 PL DE EN FP COMMIT NITY DEVELOPMENT SERVICES APPLICATIONrY© �v'3 2.5.3-8.',.5-2607•FAR 253-83.5-2609 Il I CSF`w -i4 SITE ADDRESS SUITE/UNIT e 33 71)5. 38 AO s, PROJECT VALUATION ZONING ASSESS 'S TAX/PARCEL e $ 1 ‘.1 / -5 —(•) - a L 7 0 TYPE OF PERMIT ❑BUILDING 'PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) PROJECT DESCRIPTION so 9oCI1O/5- e7"--'CT ft)----n tl Ell 7 Detailed description of work to be included on this permit only PROPERTY OWNER NAME KO) R i 1 s y� 4611 1/ � / PRIMARY PHONE MAILING ADDRESS V —r-i4 (� E-MAIL CITY 3 3705 3 1 s • Ft"D, uwA s&4 2�93'o NAME PHONE w-A54+1 ngrnAJ aofaeos/or► 5VC 4i-Z�- 135`3 MAILING /�/ADDRESS n, ' / E-MAIL CONTRACTOR I .5 c+I` (+ n e Al c CITY STATE Z}e, _ FAX 6/0S 4 WA STATE CONTRACTOR'S LICENSE ii EXPIRA ON DATE FEDERAL WAY BUSINESS LICENSE• w�1SH1 C :SefS"S-KQ. .�/ #- //2 NAME PHONE APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX PROJECT CONTACT NAME PHONE (The individual to receive and respond to all correspondence MAIL MAILING ADDRESS E-MAIL concerning this application) CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME 0 OWNER-FINANCED 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 t city as a art of this appli7c( atiion. SIGNATURE: S ‘ ,--t -l- DATE / /0 PRINT NAME: - - 0 I A--) �� -e-7171.11 5 Bulletin#100-Apri 14 2010 Page 1 of 3 k:\Ilandouts\Permit Application • • ............................................................................................................... VALUE OF MECHANICAL WORK S (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 fivctures to remain. AIR HANDLING IJNITS 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 ... ••:,...;•-•r•-•: Indicate how many of each type offvcture 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(Kiectric) HOSE BIBBS SUMPS WASHING MACHINES Rim, • • ••••:,•-•:•:•—••••)---••••••••:•:,•:••••••••:•:•:•:•kr:•:•*:•• CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE Ka Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? 0 Yes 0 No 0 Yes 0 No . 'P • :••4' • • •••••41.P.••:::::"0:4.04:44 • •V• " •.•••.; 4iM-4 ::.............. AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE FIRST FLOOR(or Mobile Home) COVERED ENTRY GARAGE 0 CARPORT 0 EXISTING PROPOSED TOTAL Area Totals WJWS ESTIMATED SELLING PRICE$ #OF BEDROOMS . . .. • : •,..... •. . .•. • cso,,:e :,,. . . Area Construction #of AREA DESCRIPTION Occupancy Group(s) Additional Information in S.uare Feet e Stories ADDITION #of AREA DESCRIPTION 11!!!!!ENIII Occupancy Group(s) Construction Stories Additional Information Type TENANT AREA ONLY ............................ ....................................................................................................... Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application