13-101294 •
PERMIT APPLICATION
e neral Way
APPROVEDRECEIVED
PERMIT NUMBER 1 3 _ ( ® - , z 9 _ - MAR 2 0 2013
l TARGET DATE
CITY OF FFDERAL WAY
SITE ADDRESS SUITE/U >3g
.ii a ? / S'. A IA
- V J C204417/ Ci%1Ice j
1#1 -
PROJECT VALUATION ZONING ! ASSESSOR'S TAX/PARCEL#
$ 3/•
75. - - - - - -
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 'FIRE PREVENTION
NAME OF PROJECT LlAc--12-41
PROJECT DESCRIPTION ,--,n►k' p (�
Detailed description of work to Ike de 7zc i- 1-1.., Iii-L S''/Li., CL1 c rt-r i, F,4•••
be included on this permit only --r•X
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY 1 STATE l ZIP
NAME f - PHONE
&74eV-4-C 3 ,€,e c JLG 2,i-3-g:17.-2.o S'.
MAILING ADDRESS E-
CONTRACTOR
/A),,,2( CR4- A6 ,ecae /'I& n fi�.cl/�-4;,
CITY STATE ZIP FAX
<< lkn u4_ PU 14-32" 2.--.V3 --ks-2-2Si Z
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
EA-, e-4 rz. a tit lL C2/ 3 I /( ,20 9a •« /, L...
NAME PRIMARY PHONE ... _ ...
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PRIMARY PHONE
PROJECT CONTACT NAME'?7 /f//S772a.4 53--(01,4"12,.%
(The individual to receive and
MAILING ADDRElS�S, " E MAI // r .
respond to all correspondence //o a( ' 4 iii R �-P� /l i-►'/I h e gil&-1eAe tine``4
concerning this application) CITY STATE ZIP FAX
C-C
..
i� -Iu 0 it- 4✓il- II- 3 Z, 2-55Efs) z l i Z.
PROJECT FINANCING NAME 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
IRCW 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 Iocal, state, or federal taws 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 ci as.a p• • -application.
SIGNATURE: � ` "• 1(/// ��►• - DATE 3" `-1 3
PRINT NAME: /6i 3i/ ` 1- 7---Ac Ni
Bulletin#100-January 1,2013 Page 1 of 3 k:\1-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(commerciah)
BOILERS FURNACES HOT WATER TANKS(Ges)
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_rixtures 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/unity) 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 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
'Mar ROK'n,ARVISEENSA;;;.
FIRST FLOOR(or Mobile Home)
8i P' �. �` � a W wVkiiig.. t $ s —_
COVERED ENTRY
GARAGE 0 CARPORT 0
EXISTING _. ,,YPROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
3itt., n% :s era .t0 MASfit
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(3) Construction #of Additional Information
In Square Feet Type Stories
xi ..z'sd.
TENANT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application