11-103911 CITY Fe y IPERMIT )
Federal Wa � F CO ME PL DE EN FP
IMMUNITY DEVELOPMENT SERVICES AP P L I CAT I O AFC
253-835-2607•FAX 253-835-2609 '1 0
www.cifjoffedealtray Lon
SITE ADDRESS CIV°`- CDS SUITE/UNIT#
PROJECT VALUATION+ �ZON G �`� ASSESSOR'S TAR/) CEI w
. 1CAs� , ° 81650 `/- 0 1 5 0
_,
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING �❑/MECHANICAL
❑ DEMOLITION 0 ENGINEERINGE PREVENTION
NAME OF PROJECT ----
c) r
(Tenant Name/Homeowner Last Name) / i f I A) M ( 03k-
PROJECT DESCRIPTION " r—� cy..< -E� `� c'„G Sass
Detailed description of work to i,N fit' N e' c) $--P-,-,D 2,,,.."•-. •
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER E 4 N• 55,, , L 1,.,6--
MAILING ADDRESS #1 E-MAIL
azo t 0 b � kJe _
CITY STATE ZIP
NAME ` i PHONE
MAILING ADD E-MAIL
CONTRACTOR 1i_'c 1) S 3.....c s"'` ss4-,...��
CITY �- STATEZIPetyi�t l FAX
v
WA STATE CONTRACTOR'S LICENSE 8 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 8
NAME J(� / /s PHONE
APPLICANT
MAILING s ((( E-MAIL
CITY STATE ZIP FAX
Se---44'x-4- v.Pc el cc I`.t L
PROJECT CONTACT NAME .--) PHONE
��_
(The individual to receive and V
respond to all correspondence MAILING AD S E-MAIL
concerning this application) 4„,-.. .. "5 e..-,,s7`�`
CITY STATE ZIP FAX
3a--K 3a-EC
ALTERNATE CONTACT NAME: PHONE E-MAIL
' Oto -3A 1•2UZe1
PROJECT FINING N -
0 OWNER- ANCED
Required value $5,000 or more
(RCW 1 .27.095) MAILING ADDRESS,CITY,STATE,ZIP : ONE
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: DATE ! I I
-
PRINT NAME: '33. ._ A --1-----
Bulletin#100-January 1,2011 Page 1 of 3 k:\i-Iandouts\Permit Application
• /
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must ee provided)
Indic e how many of each type of fixture to be installed or relocated as part of this project. ?o not include existing fixtures to remain.
AIlt\HANDLING UNITS FANS GAS PIPE OU ETS OTHER(Describe)
• AIR 6ONDITIONER FIREPLACE INSERTS HOODS(co-....Jai)
BOILES, FURNACES HOT W• R TANKS(Gas)
COMPRESSORS GAS LOG SETS REF' ERATION SYST
DUCTING `4 GAS PIPING WO4DSTOVES
Indicate how many of eac' type of future to be installed or relocated as p of this project. Do not include existing fixtures to remain.
BATHTUBS(0i-rub/shower coin .) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES -' Z, "" .Rr, ,
�,,,, ...&3.,,..,..c#�''.,.. -a,_s>3,saT a,�. ,., .::~`,�,,,.aa','�:.-- „�,.&r..,x...s »i 3 � 5." :✓ ', ;, '.-:� j a,.,>.
CRITICAL AREAS ON PROPERTY? WATER PURVEYORSEWER 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
�"5, 'a S '' S a.. 1 i t,' 11. i r ,. %� • -s -'� ' .a`� s f ��
4� ,;; ,' x,'`.: ,..,,s...,�. > �x,.�.> * ,.., .2a, , ,. -,. ..bra W. .�.�•,..a:S .m,z.. ,.. .>.„c.<•..,F a€ '.,.
AREA DESCRIPTION(in square feet) , EXISTING MPOSED TOTAL FOR OFFICE USE
. �r ; " 1'r s4 cam
- . n � i
'---"--- _..-'-------....-'---..-
FIRST FLOOR(or Mobile Home) -__,-
31,g P , $ ! tom/ ,'«:- "^ ,;i LB' '
COVERED ENTRY
'. ice . -i f ''.-.:-•=4'.." .-',.'.
----'-'--------. . ..._
GARAGE 0 CARPORT 0 __ -------------_...._.-._._...._...-
�� s�Y� � ° T,;,..,'+..0 .,fix
Area Totals PROPOSED -
2AKxyu7FT ��ya� i` itis 5 nn mp, •
ESTIMATED SELLING.'RICE$ #OF BEDROOMS
...�.".,� .< . 9 'af� .._.?3n... _... ,,.. ;{ .. ..,. , -� , ."�.,
Area Construction #of
AREA DESCRI: ION in S uare Feet Occupancy Group(s) • ,e ries Additional Information
Va % ;'4:rs�'`: py4a * €fiayr, ' rg W� 7 ;q
� .. ?
this s '1x "ri:!; 7z£i.; i',', ' � .
tt
ADDI 1 ON ME
'! i'°?' '- .#,. 5 ,z' J.3' ..,w 3 4.�u?a,. �"f i :.�.1'''„,,',- :i. a 3,( � a..,e.3� 5,
.z� :..iY�„ , ., zc. ,I :. ,...�.. - .:-,'z,��^as,. ......, T...,. za��,�, �a ), ::,.x �,� ' �.� ; ,._.",.,,a�a.r.�. - s,��a•
AREA DESC',PTION Area Occupancy Group(s) Construction #of Lditional Information
in .uare Feet • .e Stories
Ft!�'�`� a 8 e �`�., �� '�$ 9 T � _ -- V rak - � � i. ���'I:j � �: ,tri
'<. a .: ' .: . ,.
TENANT AREA ONLY
°: t " ya a A ° 5, '4,,,,,
, fiA $ s s3 ' ?
a i ,
10 ' ^ i1', re ' inn ' . . 1
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application