14-101482 . ., 0 RECEIVED
CITY OF
A, APR 012014 PERM
IIWAPPLICATION
Federal Way
CITY OF FEDERAL WAY
PERMIT NUMBER / 1-Y_ / 0 / D - qa.____
TARGET DATE
SITE ADDRESS SUITE/UNIT#
137-0 S a ` °� S - c c�-4-L w�i gga
PROJECT VALUATION ZONING A6 ESSOR'S TAX/PARCEL#
$ 14 , `F01 °I I Do D - 0 C O
TYPE OF'PERMIT ❑ BUILDING ❑ PLUMBING E MECHANICAL ❑ DEMOLITION ❑ ENGINEERING'FIRE PREVENTION
NAME OF PROJECT C LF&L-A'I`u adz.J 4 -( BLD E� A &IN0 B N
PROJECT DESCRIPTION
ADP Nei") ,�,r-i 5' 4($r C v^^ '7a P, ur
Detailed description of work to (A-A 0 P _
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER j4 6 Al Oar, P -b P Th LC
MAILING ADDRESS E-MAIL
Arw : iA PfaT Po Box • - 7o 6
CITY STATE ZIP
/21)/41-�wP eg / azoS
NAME PHONE
M.at Co',"y;i2✓c t o/J
MAILING ADDR S E-MAIL
CONTRACTOR 7 e-� �` `� 47 fi
CI KE N17-- STATE ZIP 1 ^ FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
AQ-04EI Vi Dit. 4 / i / 15 QO"Loi 44.3-po- a .._
NAME PRIMARY PHONE
1cn CV' 7i)la '74 ; - Zts¢
APPLICANT MAILING ADDRESS E-MAIL
-f/,,.€,m,I t eV to f Co 1S I i.
CITY STATE ZIP FAX . �w�^
2'53 . 9'3Z• 32)),
NAME PRIMARY PHONE
PROJECT CONTACT S g .4"S Ai/U c-Avy rr
(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.
SIGNATURE: -...1-...1.1 c:-_=))--,--.....JDATE '4"/ I i /4-
PRINT
PRINT NAME: 'Tel) Q�
Bulletin#100-January 1,2013 Page 1 of 3 k:AHandouts\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(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 offixture 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?
'54Yes No Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
;ate;
FIRST FLOOR(or Mobile Home)
SECOND FesM,': 0"
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe) ,N
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY"'
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL-NEW/ADDITION
Area Construction # of
AREA DESCRIPTION in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
.. .�.,.'' ��a\...�... .., >,�., c" •�, �a'«ate �. ,...". .. �,.,..�.
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
AreaConstruction Group(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDING •
TENANT AREA ONLY
PROJECTA tEA ONLY u \ L y r
Bulletin#100-January 1,2013 Page 2 of 3 k:\Handouts\Permit Application