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09-104537 / ZECEIV ENO CITY OF t�El PERMIT SF MF CO ME EL PL DE EN AFP Federal WaVV 1 9 ?(?.':1 COMMUIV771 � E ,�ES LI CATI O N / I 253835- 0 F 3 3 OPE D E RA mwui.a uo.a er wai.v SITE ADDRESS emSUIlay S 3 - 4 - ST Nee-7- SUITE/UNIT TE/UNIT# ZONING ASSESSOR'S TAX/PARCEL# Z. 0 2 ► 0 y - t 3 j pRoiker NAME OF PROJECT q�-p (Tenant or Homeowner Name) _0 W a w LI BUILD��t; S'Cfil PLUMBING ❑ MECHANICAL TYPE OF PERMIT xy 9 LITION ❑ ELECTRICAL ❑ ENGINEERING 1r FIRE PREVENTION V1/4,-1 ) L�,� ,s 0L-1-Ab F ul- 4L-6r"-w, PROJECT D' 's' i IO* " Detailed r•9r on of work to � ✓ roifrc be includ•. on this permiteq9.1y Gy\g69� ` w PRIMARY PHONE PROPER c ," R i ' (T Q L 1)6A lel.c. ( ) - ©ate MAILING ADDRESS,CITY,STATE,ZIP E-MAIL 2-04 S. '1%431 5 44 2- OWNER OWNER IS ALSO: D CONTRACTOR El APPLICANT D PROJECT CONTACT NAME PRIMARY PHONE //. r'rs� s' sTSVIS A)c r (293 )833 - 2-4 8 •NTRACTOR MAILING ADDRESS.CITY,STATE,ZIP FAX 6' 106 + ra at Usoi-r-€ (zs3 ) 73s o1 �3 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# Y2..c Si.JI ®SS WA.) OG / 16 i I ) ICH -OC:040 �-1 Cx) 3c.. NAME PRIMARY PHONE APPLICANT F'RF S1 CSS bV j (Z�3) S�j- 2 LA MAILING ADDRESS,CITY,STATE,ZIP FAX 206 FAr-y•rt/A+'c (R(J iV , SUlrc ( LS 3 )")3S - 0 i t 3 PROJECT CONTACT NAME PRIMARY PHONE (The individual to receive and FitAroco P C 'i2- l;-z_ (as-3)d 3 3 - 2 �/ respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX concerning this application) Zc) 1-A— 0,0 SOTE:C (•-. ( ) - ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL CAA(Sr (2S3 )g3.3 - R S F0,40KPC1,=lac — 3+ .ter PROJECT FINANCING NAME El OWNER-FINANCED Required for projects with value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE (RCW 19.27.0951 ( ) I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation and defense of such claim),which may be made by any person, including the undersigned, and filed against the city, but only where such claim - •ut of the reliance of the city, including its officers and employees, upon the accuracy of the information supplie. . e ct , a par .f this application. SIGNATURE: DATE I ) I b I CCI PRINT NAME:, 17-711A1.)(0 TPA Bulletin#100—4/21/2009 T Page 1 of 4 k:\Handouts\Permit Application S 11111 MECHANICAL FIXTURES Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) Indicate number 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 OUTLEIb OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(commeredal) BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING FIXTURES' Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. BATHTUBS or9ub/5howerCombo) LAVS)Hand sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS)KI bo(vuuniy) WATER HEATERS(Ek.,(,-(e) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION PROJECT VALUATION 1 7 31.y3 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 RESIDENTIAL 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 Construction #of in Square Feet Occupancy Group(s) Type Stories Additional Information NEW BUILDING ADDITION COMMERCIAL- REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Construction #of in Square Feet Occupancy Group(s) Type Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT.AREA ONLY Bulletin#100—4/21/2009 Page 2 of 4 k:\1-Iandouts\Permit Application