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13-104064 ( • • CITY OF PERMIT APPLICATION Federal Way RECESEPI12 VE2013L) PERMIT NUMBER - /t V l/� «(...✓✓✓ (.% — CITYTOrFE AL WAY SITE ADDRESS cos SUITE/UNIT ii 3t/Z/D 97* .4c'6 Sea11( s'u,'46 Its ii PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S an TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING eN'IRE PREVENTION NAME OF PROJECT 5.91r�- /n4 x ,,Q PROJECT DESCRIPTION ""r,'s'7 NES S1,QI"►KC-/l� 5 740NLcry e6-et,,,-9 /j,(6 Detailed descnption of work to GO ACt.F /•JEW Poo.,41 Ate ,bElw 7 eA.AU/re/ coat .:I be included on this permit only (A)14,--ti 6GIS' A/C . (5 IQ 61,J reO0‘41 5 NAME / r PRIMARY PHONE PROPERTY OWNER ,SON 4 i � -iA/S (N �r &�. MAILING ADDRESS �(/ 'Jn'L. AL.4,0 ��LL�� E-MAIL CITY /A STA"':::"'!!!/// ZIP k NAME PHONE IQ0/e-fhwC.f / 6 sYSrf ,s 14G ZmG-772-7562 MAILING ADDRESS E-MAIL CONTRACTOR 7F/5 5. I O rO n 711 517z•1. 0/7/rie&NW/jifE'Svf is .C6..-1 CITY sFAX /1\s/1\sl<c-"v f- STAT ZIP g. �'Pa 3? Za,G-772 - 756 y WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# { N©2Tt{F5 I2g c / / */ / iy ZD-f - I ( qz,7-d®. (3L 1 NAME \ PRIMARY PHONE I APPLICANT MAILING ADDRESS N. E-MAIL G Itott::: X CITY STATE ZIP FAX NAME PRIMARY PHONE PROJECT CONTACT ,eq-e--/< l�of-fl7 . ZAG- 77Z '760 Z (The individual to receive and MAILING ADDRESS L E-MAIL respond to all correspondence 7 E 15 5, /00 57 01ni / i/kvE concerning this application) CITY STATE ZIP /C' J lA JA 9K 3z gAX r Sic M 4,6©0< NAME N/r"'r- PROJECT FINANCING C � OWNER-FINANCED Required value of$5,000 or more MAILING ADDRESS, ITY,STATE,ZIP (RCW]9.27.095) �!/�.Ji- 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 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 relia'ce of the city, including its officers and employees, upon the accuracy of the information supplied tot y a pa •f th' • ication. SIGNATURE: ,O/�F� ,,�P�'' Al., - DATE 9.--/ -13 PRINT NAME: C�� A 717/-r- T14 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 install or relocated as part of this project. Do not include existingfixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIR CE INSERTS HOODS(Commercial) BOILERS RNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING PERMIT ViALUE OF PLUMBING WORK Indicate how many of each type of fixture to be ' ailed or relocated as part of this project. Do not include existing.fixtures to remain. BATHTUBS(or Tub/Shower Combo) LAV (Hand Sinks) TOILETS WATER PIPING DISHWASHERS NWATER 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 $ I r qr3 EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? V U FA/14C-4( i Yes - No o Yes No KfIcj 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) Area Total EXISTING PROPOSED TOTAL **1VEW HOMES ONLr* IMATED SELLING PRICE$ # OF BEDROOMS COMMERCIAL-NEW/ADDITION AREA DESCRIPTION Area Construction # of in Square Feet Occupancy Group(s) Additional Information Type Stories NEW BUILDING �mTION. COMMERCIAL-REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION `�e8 Occupancy Group(s) Construction # of Additional Information in Square Feet Type Stories TOTAL BUILDING TENANT AREA ONLY6l4;42.-e.� 4(SCEs!cl y1 d / _ /✓ PROJECT AREA ONLY 5 < l C( it, 1440 d 1 v fit S/t.vt e �-00 S -^ g90,1- i L Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Pernlit Application