14-104957 11‘. II PERMIT APPLICATION
CITY OF
Federal Way
RECEIVED
PERMIT NUMBER _le.....— l L' _ SEP 2 5 2014
_ TARGET DATE
SITE ADDRESS
CITY
SUITOFE/UFEDERAL>S WAY
ssI0At)1 N‘e1 s_ �. Ipc(
qvPROJECT VALUATION ZONING ASSESSO 'S T /PARCS# 5_- O O
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING tgFIRE PREVENTION
NAME OF PROJECT 1()))-S G, U ur- ni pg
PROJECT DESCRIPTION —IT-Detailed description of work to rI\CL �r)ie i N_ S ° .='' ,
be included on this permit only n � o / nne � /
/�`�° "-1-�(�c.A-re l Z.- �,P,2 I N.IL-1 tn,
NAME ,PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
-U1Vi CC-VZ-A-(_, > FI'24s- I I 2 3- -
MAILING ADDRESS E-MAIL
MAIL
CONTRACTOR ,t. uZl e -AtM ESL ( J le-Pi- lee i".4411 (! Fmc-e4-tb ^
K.1 L C
CITY STATE ZIP FAX ��I4-
( I 14ja u - ctk3z', 253 -c:s7.- z3i
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
EWI,i;-1 .A FL at c;0 M.IZ 12_/3 t / I t
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME ,�iit� ii� PRIMARY PHONE
PROJECT CONTACT t""F) � t"I-1 v( S i1L zi ZS"j -6o6- 12,1
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence t 1.V Z( Ck A WV elk 0-. ) 1'-P
concerning this application) CITY SATE ZIP FAX
-� •
1�L4 4_ nli 3'2S . 5 -eS7-23)Z.
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 th city as a part t1;41,ppli on.
SIGNATURE: I DATE 9„' 2V- /
4—
PRINT NAME:
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
io
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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 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(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ t ^1 cry
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
(Yes ❑ No ❑Yes El No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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P r f ff'V/. A ra
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GARAGE ❑ CARPORT ❑
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E OSTDQO PROPOSED TOTAL
Area Totals
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4 ,00 1W41(1* ,�¢17:4,,,: ,'k ,,+� ' 1.'�,
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
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,
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet pe Stories
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TENANT AREA ONLY
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application