17-101323 sem` PERMIT APPLICATION
< CITY OF
PERMIT CENTER+33325 8th Avenue South + Federal Wa ,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permit,Cy. ,VExDvay.com
PERMIT NUMBER r _ l V ( 7 3 _ FP MAR 2 2 2017
- — — TARGET DATE
CITY OF FEDERAL WAY
SITE ADDRESS
COMMy /0��'it'IT`#/FLOPMENT
359oi9- 1677—'MI6 So. FEc•ERAL LJAy, wi A. 47goa3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 9e90, 00 z i Z I O 4 _ 1 O S
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT `app BEAN Ee N S
PROJECT DESCRIPTION 2616111: ( - BEAM DE-rare)R , eauarer 0'2146. Foe I6wrJ -r14E
Detailed description of work to L1hiE DEViCrc,, DE PQ.OIQAM GEe44A
be included on this permit only A
1:opLi na)t S Li is E.
C.yP' +simOF Cem utas Fe,zob st LD e- r10
NAME�-I� PRIMARY PHONE
PROPERTY OWNER f Q) e4r,L 14*j ' C- L LST eu d Cps)) 945- 2660
MAILING ADDRESS E-MAIL
556P-1"-S-8 AVE Sb> •---^
CITY STATE ZIP
ea... 1...3A-ii wA 9soa3
NAME PHONE
S M p .Ex-6e4oh/ELL (lob) z'l l-/*-o
MAILING ADDRESS E-MAIL
CONTRACTOR 4/5,1D /( AUE �O, 410o -�-
CITY STATE ZIP FAX
5EArre.�. LLA 9g16 g (ZOO 2q1-. 1Sdo
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
et S1MPLL* 18S BCI OS / 12, /'IS
NAME PRIMARY PHONE
FWSD .SEEcuelry (2,1.) 396.-SoS7
APPLICANT MAILING ADDRESS E-MAIL
33336-get AVE. s0, 'SI°° o mask/3441s.0rai
CITY STATE ZIP AX
F60y quos (3) '1 , zZ'3'
NAME PRIMARY PHONE
PROJECT CONTACT 6 -710 i►nd,�{Z4Sk
T W "1 (Z h) 316-sas-7
(The individual to receive and MAILING ADDRESS �E/-MAIL
respond to all correspondence 35550- �' A�1L 53, -14litW1G$itA PPs.0F9
concerning this application) CITY STATE ZIP AX
FECEPA(_ 1.�9-v 1.43/4 ` SMS 13)gt4-S-2297
NAME 7
PROJECT FINANCING ❑ OWNER-FINANCED
When value is$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 arty 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.
40c:94
SIGNATURE: I DATE O3-22-1 7
PRINT NAME:-rt'.� -Mc i►'119-5?r'l o>r- K-i
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK 4-1,
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
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 IIRINAT.S OTHER(le.Scr;he)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/utility( WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
1 GENERAL INFORMATION 1
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
I $
EXISTING/PREVIOUS USE LOT SIZE(Is Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No n Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
................................................................................................................................................................................................
I
SECOND FLOOR
COVERED ENTRY .
................................................................................................................................................................................................
DECK
................................................................................................................................................................................................
GARAGE ❑ CARPORT ❑
................................................................................................................................................................................................
OTHER(describe)
................................................................................................................................................................................................
EXISTING PROPOSED TOTAL
j Area Totals j
I_ **NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ 1 #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION ..
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS 1-
Area in Construction # of I
AREA DESCRIPTION Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application