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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