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Federa r*RMIT SF MF CO ME EL PL DE EN Fr-
�� 3- s iitICATION
COMMUNPIY DEVELOPMENT SERVIC
253-835-2607•FAX 253-835-2609
www.cttuoffederatwa u.cum
L O
G
SITE ADDRESS
3-l00/ S. 3a & . ed aJ Lv
SUITE/UNIT# ZONING { ASSESSOR'S TAR/PARCEL#
0D / 6 a / d � - 9 0 o /
s ,' ,; � ,q, ', ,Z° a rt .. � � ,, ya>,a.- z.a .r
NAME OF PROJECT
(Tenant or Homeowner Name) eteetde o 1 L T/
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING AKFIRE PREVENTION
intP .ems/S z ./' *A-"�.-/ems -s4-"t- �
PROJECT DESCRIPTION C' (�icLly7tij?�(j ee./ Gc.)Q /< PIC I C Llt
Detailed description of work to
be included on this permit only
PRIMARY PHONE NAME
PROPERTY OWNER - �/4C ---e OW(CC„ 4C--(1 Z-L
( . ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
,D 4 ''VIII 5� .&r 4)11 1:8%-z V
OWNER IS ALSO: ❑ CONTRACTOR J O APPLICANT ❑ PROJECT CONTACT
NAME ,z-' PRIMARY PHONE•
/k i e 5/ei 5 / /11 - )9,-26. - A 1.-)
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP / FAX
//D/ - 5.y" due 7 a� ) 4 °/ �/(�s3)81� /02-/�
WA STATE CONTRACTOR'S LICENSE# / EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
.6 4 4/7 7-71 PS /34.07- , I I / Z_ //D /9-g7-66Oogc-,o- .
NAME PRIMARY PHONE
APPLICANT C qrh`C• '' ( ) -
MAILING ADDRESS,CITY,STATE,ZIP FAX
( )
PROJECT CONTACT NAME A PRIMARY PHONE
r
(The individual to receive and a'n/es v 3)�`/M 7 a�s�
respond to all correspondence MAILING ADDRESS,CITY,STATE.ZIP a FAX
O G
concerning this application) 4q53) /4. 4.,-/4,
ALTERNATE CONTACT NAME: PRIMARY PHONE . E-MAIL_
( ) - J n LaCe'5 re-.evrw
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) ( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property T 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 ofcers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
` O.1
lL __, DATE q/ 3//
d SIGNATURE:
PRINT NAME: A G Cd C N J
�/c--
Bulletin#100-4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
• •
Value of Me hanical Work
$
(A
COPY O F
BID O R E S
ESTIMATE
BE PROVIDED)
remain.
not include existing uctures to e
Indicate number of each
type o fixture to be installed or relocated as part of this project. Do no gf
f hJP f.1` P f P J
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
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not incbidp 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(E¢chen/uuhty) WATER HEATERS(Ele niq
HOSE BIBBS SUMPS WASHING MACHINES T[ 137 YTft11RES',;,
r�
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 0?) 3/
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes ❑ No XYes
❑ No
IZESIbENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMEN
'r
FIRST FLOOR(or Mobile Home)
SECOND:FLOOR ry'''
COVERED ENTRY
BECK ,..�..: ��„. <,,•.! � �� '': �. :• �� .._..._........_...._._........_.........__......_.................
GARAGE ❑ CARPORT ❑
',OTH (dessnbe
;. ��? M:. as _=�, �. • � .-:.d � ,.�„',.� ... .� ��_ _...
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION Area Occupancy Groups) Construction #of Additional Information
in Square Feet
Type Stories
NEWT BUn nnv e
a
i w
ADDITION
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
TOTAL BUILDING- ' - _
TENANT AREA ONLY
'PROJECT AREA ONLY
Bulletin#100-4/21/2009 Page 2 of 4 k:\Handouts\Permit Application