15-101026 0
j
CITY OF ��� PERMIIIIAPPLICATION
Federal Way VAR 0 4 2015
CITY OFJCDb )FEDERAL WAYD
_
PERMIT NUMBER / 5L
0 ! ?_
Yom' TARGET DATE
SITE ADDRESS SUITE/UNIT#
331 t S I s` wpd, S. 2 c"
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT biz. IM yen.S Pc ws..L- T
PROJECT DESCRIPTION ite(Detailed description of work to Aron ! r2e(occ. _ fe rt AVA-4 tivS Qvc Ahet,., T. 1.
be included on this permit only
NAME ,�A PRIMARY PHONE
PROPERTY OWNER C u Nf} YI_ `" `o i V KW e S eCci lGJ.
MAILING ADDRESS E-MAIL
2(.33 'ks-rLAti AVE E 5 itte 3oc.
CITY STATE ZIP
SeatrrLC will 1k102_
NAMEPHONE
irMr2tf-r tta iacrrgen&, INC_ . ZS-9 2G-22/o
MAILING ADDRESS E-MAIL
CONTRACTOR
27o-7 70 i E
CITY STATE ZIP FAX
T,4COSUA u44 Iriv/ zs;-1t2- G rS0
W STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PAw FP4f49cF poi s- iib 1°I -'11-10\188-on-et_
NAME ` PRIMARY PHONE
)4404Q /4S (4dcac fr1
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME 3 + PRIMARY PHONE
PROJECT CONTACT r.. 6G.cc, 25-3-Zai 3Y4;7
(The individual to receive and MAILING ADDRESS E-MAIL t( 1
respond to all correspondence )i t a�Y.e3k 42!'e .Cw-
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ^ /4 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,,SSTIT�EE,ZIP PHONE
(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 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 cl 'm arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t e ty art of this application. -
SIGNATURE: DATE 3 3 -/5"--
PRINT
JPRINT NAME: .N AN"- D k.C C a--
Bulletin#100—January 1,2013 Page 1 of 3 k:\l-landouts\Permit Application
• • •
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(commerci1(
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING 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 FIRE SUPPRESSION SYSTEM?
Yes ❑ No ❑Yes Vo
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEME T
FIRST FLOOR(or Mobile Home)
................................................................................................................................................................................................
SECOND FL•tR
COVERED ENTRY ,
ECK �
GARAGE ❑ CARPORT ❑
u a,�
OTHER(descrab
EXISTING PROPOSED TOTAL
Area Totals
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 ., u
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
TOT BUILDING
"lt
TENANT AREA ONLY \ `.L1 S
r 1�
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application