17-100396 ,40
• •
CITY OF 4A PERMIT APPLICATION
Federal Way CEND
JANCo � �N ,� s 217
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PERMIT NUMBER ( _ 1 _ P Qc
TARGET DATEarifTIP D"��NW
SITE ADDRESS SUITE/UNIT
3 Z D5 P t=,G cf
-• -CT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
Ci33 _ 15 o _ a < <
4' a RMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING XFIRE PREVENTION
NAME OF PROJECT G� cc I
ict
PROJECT DESCRIPTION wr
iG
Detailed description of work to Lv "I rt c $e(L, N R._ 15-re"-
be included on this permit only
T iJ A/ b.J (L E T A 'l 4 t t-D i ae-
!�T- Fi-A-Wcr M &41( P fekra- C tic wit,cii_cTil,dvAbo)
NAME PRIMARY PHONE
PROPERTY OWNER RA/44 r nfV'a,'T-ivt fliv-r
MAILING ADDRESS E-MAIL
Po ( O)C z-t -0F3
CITY STATE ZIP
NAME • PHONE
#1-G4 C-vc"5Tx, a j 2-5 112-
MAILING ADDrt E-MAIL
CONTRACTOR
`T] a L,/T -t 5t
CITY STATE ZIP FAX
VI 13e)3Z-
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
fI-iL(.4 el 2- "l Pit 4 i [ /
C.9D 624AECA) oc' Z03- Zt es 1"
APPLICANT MAILING ADDRESS E-MAIL
h✓I/-e A-s /A/T rro • 'vL_, A co aic1/L..2-/'
CITY STATE ZIP FAX Y'/V c (4-t V'' '' ^v
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,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 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 of this application. ^7
SIGNATURE: _ DATE Lif
p — l `
PRINT NAME: ,9
Bulletin#100–January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• • •
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 17—
Z 1 4-.5
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) C lj P( /V11-1xNLS
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(glectric)
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(Ira Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No Yes Li No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING ,P1!„0:0,,,,,SED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
gal moi' , ,,,, ''' 44::44 •'s't r�r.,� x �f y5''/' ............ .. .. .. ... ... .. ..... .. .. ... .. .. .. ... .... ...... .. .. ..
O'c
! xt"..Y ),' of q/a .��yy
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
sConstruction #of Additional InformatioArea
AREA DESCRIPTION 07uPancy Gr°uP(s) n
in S•uare Feet • •e Storie
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in S•uare Feet •e Stories
TENANT AREA ONLY
Bulletin#100-January 1,2013 Page 2 of 3 k:\Handouts\Permit Application