11-102824 i
* Fi E L - 1 ® at r °I–LI
� 'C, c,- s ERMIT
F_ . 1). ay �,�'* SF MF CO ME PL DE EN le
COMMUNITY DEVELOPMENT SERI S , PLICATION
253-835-2607•FAX 253-835-2809
Pww.aaA; atwau.mm e+�.�✓�`
SITE ADDRESS r 3 SUITE/UNIT 9
isl
ASO (.41A. 1 S . �c ra,� W&/ °l g003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL I
$ G,230 !I q - O02.1 (3 -
—
- - _
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ HANICAL
0 DEMOLITION 0 ENGINEERING IiY�PREVENTION
NAME OF PROJECT
/' (TsvEu5 re%/01NT
1, (tenant Name/Homeowner Last Name) 1 d ci e vO.�I l /��^ to /r M oNi e J T . }
_ PROJECT DESCRIPTION
151.9f�,� ed,gj�.Cl a a .i Ci/•67c/lV ir.4J cover-43e Gv I M o4bev tq o 4c,/i
J Detailed description of Mork to .CCM..,47f, $1 ole nre 74 C�O�'7 d� Z A-.-• eid o.,/ nefri
be included on this permit only e1asalimmissimi . 1
vcr,erl -a Ti�vc Al it ..r 11.-.- -c h I w,I I
A.
iFf
n (+ ONE
,'_ PROPERTY OWNER 5o^U t tr U`r c,L C Oc-L,/ V` Z--587-f (a
(GCVO VIS 4u-s i-1./ J(• S1 1028 a 1®n bsrea l S. Coni
31 C Sea '�C�. u�a ZIP
%10 l
1t, 9, NAME N 5 (.0 AQ tn�" f S 4h4°118 Lac. 57-7627
MAILING ADDRESS
CONTRACTOR Z b Rl -ds dd s' - 2S� Z fsrat cS' dnleyhlol`Y,S.G�'
CITTECYt-W c iT� g$oo� y2{411ta-04D844
` , WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE I
iJ .... S'T�N acs"ZS M Z 7 `l Ze1 L Z1-(4 10048-u0-,�L
04 t NAME PRONE
Teri c ,+h 925-9s7-7427
`v.... 6 MAILING ADDRESS
T APPLICANT Sw'C � eaik �or ve Sa.�
CITY Q STATE same-
FAX �+n Jwif �.
PROJECT CONTACT NAME PHONE ��"-•`
`�. (The individual to receive and �A
respond to alI correspondence MAILING ADDRESSStialf‘eEMAIL
concerning this application)
O CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME o OWNER-FINANCED
Required value of$5,000 or more
IRCW 19.27.0951 MAILING ADDRESS.CITY,STATE.ZIP PHONE
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 mg 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 Chi of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such data),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 city as�t of the appHcatto
SIGNATURE: -4 DATE L/
.13_1(
PRINT NAME: j
Bulletin 4/100—January 1,2011 Page 1 of 3 k:%Handouts\PemTit Application
R •
MECHANICAL FIXTURFS
VALUE of MECHANICAL WORK $ _ (a copy of bid or estimate must be provided)
Indicate how many of each type of,f lxture to be instnliprt or relocated as part of this project Do not include existing fixtures to remain.
MR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
MR CONDITIONER FIREPLACE INSERTS HOODS(commerclsq
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
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 Tteb/Sharer combo( LAYS Oland used TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS antchm/uway) WATER HEATERS(raccuaci
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 PIR9tXNELER SYSTEM? PROPOSED FIRE SUPP SYSTEM?
VfYes 0 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
GARAGE 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAl. .
Area Totals
"NEW HOMES oNiLY'*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL, NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
New BWLDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL.BUILDING 31 fa
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\HandoutsWennit Application
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