15-101958 INED II
�� ° APR 22 2015 PERMIT APPLICATION
Federal Way
CITY OF FEDERAL WAY
PERMIT NUMBER5 1
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— ` U — TARGET DATE
SITE ADDRESS SUITE/UNIT#
/e0C- L) 3/7/x1 Pt /1 E if_062/ J4Y, cog
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ qy� °= 0 / o - 0 0 I
TYPE OF PERMIT ❑ BUILDING ❑PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING .�FIRE PREVENTION
NAME OF PROJECT jijF,/ c / S/D
sTa4c 4 cW&7 P/P.0 SP2l�/ICL&K. SYsrg -7, P2oretr
PROJECT DESCRIPTION /// ..�y // ��/� /�,� �-"
Detailed description of work to tV /r U /GTf7 /is aU/MJb SP4LES �i�T(P !l'"V"&(£ s/J)CJv�
be included on this permit only
NAME PRIMARY PHONE�
PROPERTY OWNER TIJi/�/Et �3-_ g/3— S YS-
MAILING ADDRESS E-MAIL
/80.0 S//u) 3n/it1 ?U4CEAA��
CITY S'IfK./z cc fri� ,,/YI ZIP / k7, .d
NAME//' LL (p'JFY PHONE
5,�^/rii° fiQz SYsr iS asp g - X�s
MAILING ADDRESS E- L
CONTRACTOR
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CITY STATE ZIP FAX
?14C9frilq- u.A4 9ri/� _ X53-�gq 4 v I 2A 6°
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5/0Trla f13G [ /4 / 3i /is-
NAME
71:1
t /�/' 5V61.-F-)1/13.
``/�+ `/ PRIMARY PHONE �/ X
NAME 97/!/"[ ri I�C- J I JII J ~g "`6-11.%
APPLICANT MAILING ADDRESS E-
7 A
CITY ��6 /AA 9,0424
ZIP 9,0 FAX s3--V1/-12110
NAME,. PRIMARY PHONE
PROJECT CONTACT .J L,FF ' , (1 4'. ,/MAILING ADDRES2 E-MAILThe individual to receive and MAILING ADDRES E /(
respond to all correspondence //06 5'74 " i' ‘
concerning this application) CITY� STATE ZIP C^� �� FAX t t
NAME 17114 /AA
PROJECT FINANCING ❑ 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: ;a//%� 4 DATE / /.S
PRINT NAME: .J EP/ 5111 i7'K
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\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(or7ub/shower Combo) LAYS)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?
Yes❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
FLOOR
COVERED ENTRY
Aft'a
GARAGE ❑ CARPORT ❑
OTHER(deserlb
"" PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in - uare Feet Type Stories
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
> a„
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application