10-103262 XL
,..,,. _,. ..... PERMIT RIF MF CO ME PL DE EN FP
i Federal VVay
♦/��
row, ITY DEVELONYIENT SERVIRE UVE ICATION
25.,„35.2607•FAN 253-835-260
{V
Y'
JUL 3 0 2010
SITE ADDRESS SUITE/UNIT#
33 90 1 dY ®WA #1 3 l% 3//
PROJECT VALUATION t0 I ASSESSOR'S TAX/PARCEL#
$ 101 O c l 2 v 5 t.) L} - L l C)
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT'. „y` ILA)
( (.7.1‘.4
0
(Tenant Name/Homeowner Last Name) .--4:::) ` `,J
/
PROJECT DESCRIPTION
Detailed description of work to \Y\S.)–(A1 1 l vj C;, �e �, i c o l jxs
be included on this permit only J
NAME PRIMARY PHONE
PROPERTY OWNER IJ( 1,k) e_ t 0
MAILING ADDRESS Ll E-MAIL
CITY STATE ZIP
PHONE
NAME CiId ec_ nco, ) IVC LE 2S - 2 2�-CO-1 I
MAILING ADDRESS
j ��^ /�'/� E-MAI _`
CONTRACTOR 1 LD L�J S 1 60 61-1' re-- SE ,, e - head C? OYv -,1,rid
NV Q n'fiOv\ �-tJ STATE Z�c1 U 2 zs c /!)
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE.#
1/6 t�03m.-9 /203 cr / 23/ j / /},piled For -713611D
NPHONE
evm' k 1iread s-7 3 - e n I
APPLICANT MAILING ADDRESSMAIL
! x, 53 / Q Cri- Pc SC Lr r c ) ad ccmccst,
CI STATEZIP ,cie. FAX
PROJECT CONTACT NAME ,-- PHONE
0
(The individual to receive and .e \• Cid 2_e) if -736 S-176'
respond to all correspondence MAILINGyADDRESS E-MAIL
concerning this application) I (p C J'3 )62 O It. S /�C }t, �, i(}t c .CCYyl('z. .7L,ng
CITY/Th e_,-,A-0 so ii- ZIP V J .FAX
(k-‘2 ' 2.s-C- S Y/j
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
Required value of$5.000 or more 11--m r OWNER-FINANCED
(RC419.27.095) MAILING ADDRESS,
',Z / PHONE
/La C. 3 /0G � SE 4"1+0,1 w1- Vel-j-- 4 ZS - 226—
6071
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 ofthis application.
\ 1/2d )70
SIGNATURE: A d
DATE
PRINT NAME: e P H—ea d
Bulletin#100-April 14,2010 Page 1 of 3 k:\I-Iandouts\Permit Application
41)
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
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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.
BATHTUBS(or Tub/shover Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(metric)
HOSE BIBBS SUMPS
WASHING MACHINES
"r•"'•""`•"
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
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
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EXISTING PROPOSED TOTAL _._.
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
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Area Construction
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
ADDITION
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Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
TENANT AREA ONLY
...................................................
Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application