13-105209 •
Or~OF PERMIT 4/PPL N
Federal Way ��
• NOV 2 0 2013
PERMIT NUMBER I te 1I 9 T
_ 0 v �/ _ CITY OF FEDERAL WAY
- TARGET DATE CDS
SITE ADDRESS SUITE/UNIT#
3 c s0° tn c.:\-Neurr}edG(Vow Sr
PROJECT VALUATION ZONING ASS R'ST�AR�11
$ a 0J [ D � -
o co
— —
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL ❑DEMOLITION ❑ENGINEERING Igt FIRE PREVENTION
NAME OF PROJECT /1 i
PROJECT DESCRIPTION 1I� \s{-O.lt ?c-e-,�>7 o n ee rC, \\CSB 1, 4{- N } 't�' _ e si o r1
Detailed description of work to I.p C... Ire-- )( p e kndodo
be included on this permit only 1
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAMES 2 0
Cin der 56n t� C.� y 2c4,-3 /O -Ll3vU
MAILING ADDRESS / E-MAIL
CONTRACTOR (c A i J��l7rT�J.�Cc l] �• Segs- 1ka sc,n5Gae .'C60.1
CITY E ZIP FAX
s5e.cam e (T&, 4B 13 ci aa, 3 90--y 3 01
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
SPt -55290P-0 P.o (p / x.157201,
NAMEPRIMARY PHONE
S�,vv� a.5 Con .c I-o r- 5 cam,,t.
APPLICANT MAILING ADDRESS 5 cum
e E-MAIL g1wL
CITY S G.a/\ °L STATE ZIP FAX ,A^
NAME PRIMARY PHONE
PROJECT CONTACT D C)Wt.. Co.,6- I S e o 2ct, _3 cl v` (I 3c30
(The individual to receive and MAILING ADDRESS s E-MAIL
respond to all correspondence 2(0 00 A % 9 b r v . 5 ec,,`� t e 5 .cow)
concerning this application) CITY ATE ZIP FAX
Sea l� �� g( 3`I 2-15(A--3110 - 1301
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 •-. a •art o • •plication.
SIGNATURE: I DATE `/ C�fl 0013
PRINT NAME: a(Lf CAD o f li e r-1 Q n
Bulletin#100—January 1,2013 Page I of 3 k:U-Iandouts\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/Sbowercombo) LAVS(HendSinks) 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?
❑Yes o No KYes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
mow
FIRST FLOOR(or Mobile Home)
7:Iggloimmotri,r*Itaintiticautressm, lormtvliim
COVERED ENTRY
y rskiakOSir .
GARAGE 0 CARPORT 0
uS
Emagareas
EMS17RO PROPOSED TOTAL
Area Totals
... - r * oA: rte .,.'.
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in •uare Feet y e Stories
ADDITION ._
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in uare Feet a Stories
2 1 .:s- fi ._
n'x ;" :"=ail rlsLi' FAMMISMA 5r itsF rt _ w
z
TENANT AREA ONLY
s xsrMa. 'nom `.,,a g1,a sd a sem- 4 - €N _ M i s r
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application