12-103784 RECEIVT,•
037
arr ofERMIT SF MF CO ME PL DE EN FP
Federal Way
COMMUNITY DEVELOPMENT SERVICES ' A LI CAT I O N
253-835-2607•FAX 253-835-2609
www.c:tUo((ederafwau.corn CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ /- fir�!
TYPE OF PERMIT CIBUILDING 111PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) D tel 1r S Tl U,jt 1 E
PROJECT DESCRIPTION " c>1� ��T'T l-t - s row /Jlr InI tr.4.-LS
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER S1 -+ENC.C1 P ' / 4 ASS 6 ZQ(.n -3 L5 —1 OS-a
MAILING ADDRESS E-MAIL
'210 33 E,as1L.-Air..-E AVE E 1 S.ttTE 30r. [ ! (' S�cl .c_ew•
CITY STATE ZIP
�>✓A"1rI—E W c1 (:)sii i
NAME PHONE
PiR-E- cay - it+g
MAILING ADDRESS E-MAIL
CONTRACTOR F�O►JTAC�tr ISD t‘,.) LSU I'T1r G 4'I,L.6'ors4Te.sS"tew`5
CITY STATE ZIP FAX
1~'ssc�iF—;c. 9g( 47 S'S — 735— o a l 3
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
F•IP-s5PJI 11-bbi i2/ 31 / 12- i"-S7- - -gL
NAME PHONE
1 r�'ER-C.I.J
DAV 1 S
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and ' DAVA S
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) SAS'^ ?�'✓
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required value of$5,000 or more
(12CW 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 F eral Way as to any claim(including costs,expenses, and attorneys'fees incurred in
the investigation and defense of such claim),w ch may be made by any person,including the undersigned, and filed against the city,
but only where such claim arises out of th _reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part o his application.
SIGNATURE: DATE ?/..14/1
(c/
PRINT NAME: 7-4+-EPI-6 J QAy'IS
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
•
MECHANICAL FIxTuRE0S.....
VALUE OF MECHANICAL WORK $ 13
3 0o (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) �)£.4 SPR 1 71<�
BOILERS FURNACES HOT WATER TANKS(Gas) WET s01.S
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how many of each type ofjbcture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or rob/shower Combo) LAYS Oland Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(titehen/unto) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
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 0 No
RESIDENTIAL - NEW OR ADDITION
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 ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING 7 2-, ._ OPS--A _. Jr/S E L
TENANT AREA ONLY 4 `Y7 tom...`
PROJECT AREA ONLY. Cj.r-�LS'
Bulletin#100—January 1,2011 tt Page 2 of 3 k:\Handouts\Permit Application