10-103365 CITY OF PERMIT
Federal Way SF M EC IVE D FP
(0253 835-2MMUNITY607 FAX 2533-835-2609ES APPLICATION
www.cituoltederalmay.com AUG 0 5 2010
SITE ADDRESS ' CITY OF F A L WAY
5
g®I WY
PROJECT VALUATION / ZONING ASSESSOR'S TAX/PARCEL#
$ 12oo 9 2 .6 5 9 4 - D l 6 0
TYPE OF PERMIT ElBUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT ,/
(Tenant Name/Homeowner Last Name) 1f; iyjt
17i/0
�c1 �r / 4
PROJECT DESCRIPTION ""d 43/f VI0egt yr 9rr)01/ fOr/�i1 lielVCe/1&5-,
Detailed description of work to t/ / tJ
be included on this permit only
NAME PRIMARY PHONE -
PROPERTY OWNER /Yei/ 16 Her Co Val/ 253,77f PO
MAILING ADDRESS E-MAIL
WO yip 1~i2si ct r 1 /&O ��% J
CITY 56,ata
a/ Sj7 ZI%1��ie2 ( --
�� -NAME WR N�cl�5Yf7 PH /r(/2/f 6717
V MAILIIVG ADDRESS E-MAIL
CONTRACTOR lZ'yS//(/0'chilli bile AVL / /'7t /�y/�y �L
CITY��/ /1/a//L� STATE/ ZIP`f J/O qF FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
,r� /^ ` /elf, / / p"HON ,r 7 s,��yA
NAME r`Y e '5X7 7 Y, c ------ P2 `I7 33, 6f,!i
APPLICANT MAILING ADDRESS/ E-MAIL
..2®c Fro,i j e R04d f 1 I' C
CITYI 11 STATE ZIP 7 FAX
PROJECT CONTACT NAMExa ' f° t/A p, PHONE
pZ' M0/211)(
/21J ///
(The individual to receive and hCYI l//• 7 i �!
respond to all correspondence MAILING ADDRESS/- I (�L Ey�M�Lt C
concerning this application) )I7C Froiira(ye Boaµ l �//4 AbE t/l'e � rB�yj'tf�}' Ai�'1
CM(.1 c, c / S/r ZIPf�O�7 FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
Cray * fir 2ci,,N114,,,/15 G ' 1r�S,�s: S �I.
PROJECT FINANCING NAME
0 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
,areasa part of this application.
SIGNATURE: Air � "(17 DATE XV 14 .2q,
PRINT NAME: /4NW' Gr/J1tIt
Bulletin#100—April 14,2010 Page 1 of 3 k:AHandouts\Permit Application
• ! •
a
M 'HANI AL FIX: URE ,, ` tr,
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
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(Commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
, .1.1...,,,k,_,....,,,,,
�` WG A+ ',,0;.',
, , .. ,,_
Indicate how many of each type of fixture to be installed or relocated as part of this projec to not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER S MS URI S OTHER(Describe)
DRAINS SHOWERS V UUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/U tty) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES'
., E .A I., N ()RM TON
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?
X.Yes ❑ No ❑Yes ❑ No
AREA DESCRIPTION(in square feet) . ' EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT `'> -P
FIRST FLOOR(or Mobile Home)
SECGND f'/W,•.,•,,t)
0 0
COVERED ENTRY
r
,
GARAGE ❑ C, ••ORT ❑
', a ..
,
Area tals ERISTING PROPOSED ?.
,
AL
NEW HOMES ONLY
s
ESTIMATED SELLING PRICE$ #OF BEDROOMS
^V3a
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
NEW$UILDIriG
ADDITION
CIIIE �iC N NTS;
AREA DESCRIPTION
in `mSquareea Feet Occupancy Group(s) Construction #of Additional Information
a Stones
,;...,... ....
k e
...„4„,,,..,, ;,-f:..-,,,,...-,./„...... ......,.
.-, 4.-..,---', ,, ....,
TENANT AREA ONLY
PROJECT'ARE ONLY = f - ,
Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application