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CEDI fib
PERMI
Federal`Way v U 2 2 .c\v\ SF MF CO ME PL DE E FP
COMMUNITY DEVELOPMENT SERVICES" APPLICATION .i>ozii l T
253-835-2607•FAX 253-835-2609
www.c:tuoffederalwau.comIrl -
SITE ADDRESS ' SUITE/UNIT#
3 ., ,c./6
a / �/
/ < 5 / /
5-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1 C 0(.. q z to .- d ) - 0 / `O O
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL //
❑ DEMOLITION ❑ ENGINEERING l 'IRE PREVENTION /7(al
NAME OF PROJECT / '\ /�
(Tenant Name/Homeowner Last Name) ,'L,,/' f%�� //i��;/� ��� / i�4e:--
PROJECT
G
PROJECT DESCRIPTION L / 111 CCA (/ /7 �C
Detailed description of work to �/ (V co"/�f�y /' f j7 f (//��f t�.--.c,(07.4_,
be included on this permit only /lie 7,,,,, j/6J.4 c J- f'tc �C
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY I STATE I ZIP
NAME,/ e icYj „44I„ 66, f 7 NE
E�O�,FJ —41'7j'/2 /11
MAILING ADDRESS E-MAIL_
�1 -�
CONTRACTOR � �''j % '�"fG�C' �0i IIiIi ��� if�'sY'�e'A,�
CITY ; STATE ZI FAX /�
' !, /;r'( Gni=, 9. Y7 ?--3 7 ?,r"- c.-//.? fl
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME ��C / / 7L
'4 �49 P ON
APPLICANT MAILING ADDRESS 567-1 E-MAIL
CITY FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and -
respond to all correspondence MAILING ADDRESS - E-MAIL
concerning this application) ! -i- C-
CITY r STATE ZIP FAX
ALTERNATE CONTACT NAME: I PHONE E-MAIL
1 Ci/, , //r�6?rk
PROJECT FINANCING NAME
❑ 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 the city as a part of this application.
i
SIGNATURE: DATE
J y,^
'INT NAME: _?-4 / C ( f 1 4_I7 . ' -,.
`100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK $ (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 fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLEIb OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commeiciab
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
INET T fit„✓�
f FITI7RF F
Indicate how many of each type of fixture to be installed or relocated as part of this project. Donotinclude existing fixtures to remain.
BATHTUBS(orTUb/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(Eiecmc)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFO
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 ❑ No
,.,,.,::':. .,,,��Ti 3n4 •, RESIDENT ,..- .,,�� � t.. ��.. < ki f.
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES OA*"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BZIIL7')i G
ADDITION
.' MMERCIAL'-REMM.ti• IMPROVE +�
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY'
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application