15-102318lir
•
CITY OF PERMIT it PPLWAIION
Federal Way
MAY 1 4 2015
PERMIT NUMBER I GI 0 e)_ �� Com'OF FEDERAL WAY
-
— — TARGET DATE CDS
SITE ADDRESS SUITE/UNIT#
2 ' ' 10 2314 #c)e., 544)
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# I 0 � -
ID j 0I �G-y TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ,'IRE PREVENTION
NAME OF PROJECT 0 I `l.. G G .
PROJECT DESCRIPTION rQ s ‘ re`f
e`r P`J A) it ( e f (3`{ 5 f P-rt /
Detailed description of work to 94.✓ ✓v r i#/ 4 kb- 6 I C3C-4- I 5 tial e cic 5
be included on this permit only
NAME ‘ PRIMARY PHONE
PROPERTY OWNER c �l
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME � ti4 &) fe- (( J V 1 e L t d v PHO 2 S 4 // S'7 0
MAILING ADDRESS it)
_ E-MAIL
CONTRACTOR 6 1 `�
CIT STATE
e S fin b t Ale- `�+-4T- ZIP -6 141 FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
Aa-e it
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME ` kA-0&)
PRIMARY PHONE
PROJECT CONTACT ��*.e 1 r e-� - q.2S^ y/-7-5-7%
(
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME OWNER-FINANCED
PROJECT FINANCING
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 t e city as a part of this application.
SIGNATURE: ,....cit. .../.4tLil_
ea
DATE
`S !5----
PRINT NAME: p„si-Q 1,--.\- 1.1-,3A.)
Bulletin#100–January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
S
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated aspart of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS •• - GAS PIPE QUTLETS 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
$
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
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE ❑ CARPORT ❑
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in S uare Feet Type Stories
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COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION `mea Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application