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14-105001 RE � VED * PERMITiIPPLICATION Federal Way SEP 2 9 2014 // CITY OF FEDERAL WAY C . PERMIT NUMBER i L.1 _ /© D ® O / — / ( ( TARGET DATE SITE ADDRESS SUITE/UNIT# 3%1/S` 1 IC t A-c Sv�N4 FE0eitt..t t,,..,3 , w� 50i It Iver PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# I/ �p �" q Z CO 0 V — t2 ( S a TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT 1)(1. taAii,1A BAKtiFt .� PROJECT DESCRIPTION r Detailed description of work to IZCIOC i' t (X1 S h'A) e. fq(tA'_ 4! h � Att..), Att. t. -,e be included on this permit only ,J R V, NAME PRIMARY PHONE PROPERTY OWNER CVS A /,IUf LL Vti1 (NV'es T L Corp. 2'o4.- 325-era(g, MAILING ADDRESS E-MAIL L6 r 3 iaykSi-tAre /we E 3t91:0 `- CITY STATE ZIP ScotiflG W, NAMEPHONE Pt.-Cc%u-t r ltt= Pzo 2.53-1 ze.-22.40 MAILING ADDRESS E-MAIL CONTRACTOR 2?D" �J ti' ��/� �% 1d11,►e� Pa.{ria}���t.CaN- CITY STATE ZIP FAX iv►4 9tc3f2`f ZS3-gZt-biSo WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# PA-7rt t F419,c NAME 1 \ PRIMARY PHONE s4.12— APPLICANT MAILING ADDRE JJJ E-MAIL CITY STATE ZIP FAX NAME ` PRIMARY PHONE PROJECT CONTACT Joh"- CC` 25-3-92G�ZZe)v (The individual to receive and MAILING DDRESS tt-- E-MAILqq respond to all correspondence A 1 in l► Je K.4 104 .c7T ite .eei..� concerning this application) CITY STATE ZIP FAX PROJECT FINANCING E OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS,CITY,ST +► (RCW 19.27.095) 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 Iocal, 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 t e city a part of this application. SIGNATURE: DATE //244//( PRINT NAME: J akv` e►CF1� Bulletin#100—January 1,2013 Page 1 of 3 k:A1Tandouts\Permit Application I S VALUE OF MECHANICAL WORK • MECHANICAL PERMIT $ 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 VALUE OF PLUMBING WORK PI,I_JMBING PERMIT $ 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/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(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 FI E SUPPRESSION SYSTEM? > es ❑ No Yes ❑ 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 11 ................... GARAGE ❑ CARPORT ❑ OTHER(describe) :. Area Totals EXISTING PROPOSED TOTAL „„ **NEW HOMES ONLY**: ESTIMATED SELLIN 'RICE$ #OF BEDROOMS COSIMERCIAL—NEW/ADDITION AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information in Square FeetType Stories NEW BUILDING ADDITION COMMERCIAL--REIVIODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information in Square Feet Type Stories " TOTAL BUILDING TENANT AREA ONLY 2.l 5 o ( 'I(tvc,s> CAR R J. 1�9E 1-f ROJ PECT AREA ONLY' V 5 rio4Y`- Bulletin#100—January 1,2013 Page 2 of 3 k:AHandouts\Permit Application