17-101682 RECEIVED
CITY OF APR 13 2017 PERMIT APPLICATION
PERMIT CENTER+33325 8thAvenue South+ Federal Way,WA 98003-6325
Federal Way
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
i COMMUNITY DEVELOPMENT
PERMIT NUMBER ) , 0 I to F
PV/4
TARGET DATE I v
SITE ADDRESS SUITE/UNIT#
33um 2- 13' s
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4/2( ,cr, Rs s: a 1 3 2 ) 0 3 _ O (0 Z
TYPE"`OF`PERMIT
0 BUILDING 0 PLUMBING 0 MECHANICAL ❑DEMOLITION ❑ENGINEERING XFIRE PREVENTION
NAME OF PROJECT Kt GSI r �� egE „ctiC/irrir t m
PROJECT DESCRIPTION u p-p ades c-t ` &hd
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
4‘07-7# 44rz-
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
44 lrielep•SA't i /1-L . 706 '4
MAILING ADDRESS E-MAIL /I
CONTRACTOR 131 "►/e��� VJdb Q p l/sek.C."•-.
CITY STAT ZIP FAX I
e ufr q '('e4 24,4,- 3.7.8- '{875
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
1147T-01- --(I ?`" 123 G.,4- / 7 //74. 2 o- (-7- (60442.2--00
NAME PRIMARY PHONE 134
-naw ka 4$ Q bOIle•
APPLICANT- MAILING ADDRESS E-MAIL 12 3`
CITY STATE ZIP FAX
NAME - PRIMARY PHONE
PROJECT CONTACT
(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
When value is$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 ity as of this ph ation.
SIGNATURE: DATE if (? 17
PRINT NAME:
Bulletin#100—January 29,2016 Page 1 of 2 k:\1-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 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/uhiity) 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 ❑ No ❑Yes ❑ No
RESIDENTIAL — NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
ss �`� �/"��� 1,�� • ;. ,,,, r�f�r��;rr`�%v�i,�-',"°r�"s� �,�'�� .. �� �,:;.,," �^�ay,,,�il�fr,,J•�"�'' �5 .............................._......._._.._.._............._._.......---......_............._..------.._............—..----.._.
i ori ,fir P`F`�`r 1`s r..r.
A "� ,lei / �` / ,�.r �•l y
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
'i 4/„tv�FferJ 4.Kl A ,"' yiy�"i".�' jt i/, f -.. ��1/�1�`,O//'r yifs�lr,' r"•:,,vF�'F'............_..............___........_...............- ........_—___._..............__................__.._.... __....__
4414
GARAGE 0 CARPORT 0
�rjy%�,',�'•,.� ri.,n{,f `i,;•�'//d,�",�'��`" r�'Y%,r;'`/,�r a ;�,,; .� ��l,,r �.s;%r��A��,,3,��,�r�,�:.___...____....._.................._._...._.............. _.._......_......___.._.__._—_........___...._...__
1.44
..- F f 11N:,'`Y�+�e f :- ,- /' s/, .;? ,F ; ',3, vlrf„^Jr,'�l'Gf. ........... ................_.._.. ._.................._.._.-_............... ...__"_.___..............._ ........_..
EXISTING PROPOSED TOTAL
Area Totals
ems' .Si,�/.i, ,/a .., ,;,� ,. ✓ wf.;®. �,.,A; ".�;x,�/s r,,';, �JTr+r,.r'rf` ,u .,
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
S.uare Feet Type Stories
;'vf ,';,�'/.1,�• F"/ ,d J f� .� r �,v �'/�s mss' ;,',�" f ,ryi,'/,x / <F:`�'`k '%•^t .4 f `F ,3�`'.^ r ,?,, vim //s
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
Square Feet �e Stories
TENANT AREA ONLY
t � ads T A g 7 i.; y
t
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application