13-101636 E EI\ED
•' MY OP A. PERMIVAPPLICATION
Federal Way APR 15 913
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CITY/OF FE® J l�/ERN..WAY
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PERMIT NUMBER / /� /„ �j /„ - f
V ll/ L TARGET DATE
SITE ADDRESS SUITE/UNIT#
0 iZ /oaa .4/e ,,1,0 5
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# iv1;j' pf
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING MIRE PREVENTION
NAME OF PROJECT A g11 Si E IWO-
PROJECT DESCRIPTION �e '1D N
Detailed description of work to ifF t), ,/
5-',./
be included on this permit only
NAME aia..4 /� PRIMARY PHONE
PROPERTY OWNER aieealT��!
MAILING ADDRESS C E-MAIL
CITY STATE ZIP
NAME1 p re
'r S-21.94;......!)4/ H
- }0SI^�
-3/7423
MAILING ADDRESS MAIL
CONTRACTOR /A tIAFF)I'6,4'1'6`4
CITY STATE
313/./7,,
WA STAT CONTRALTO 'S LICENSE# , EXPIRATION DATE` FEDERAL WAY BUSINESS LICENSE#
NAME ) VI F r/�/� ��� ,.of.
Al 'P5
�tO Ctre PRIMARY PHONE
APPLICANT MAILING ADDRESS ,�/�J��-{/�� E-MAIL n -
CITY '5. -I/L `- STATE ZIP FAX li ��1iP"`�
PROJECT CONTACT NAME 0344 id'II / , PRIMARY PHONE
(The individual to receive and MAILING DREss �,(�(
E-MAIL
respond to all correspondence (n/ I
concerning this application) CITY K STATE ZIP FAX
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 =city as a part of this a cation.
SIGNATURE: /./ r DATE 1—'S —/3
PRINT NAME: /_ 1 ,I Al ,i � A
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
a
1110 •
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
PE1559 h PERMIT
-. `tndtcette°ho&vitany 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/util ty) 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
BASME1 " OSOMMIlleggSENCIEINEEMONEd f
FIRST FLOOR(or Mobile Home)
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SEOII. FI
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COVERED ENTRY
tigkaiggaitin
DECI{ d
GARAGE ❑ CARPORT 0
OTHER(desk r4
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
r
in Square Feet Type Stories
N , .l
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
r.NTOTAL BUILDING s s h. rcK s e v 1 r - I
TENANT AREA ONLY
PROJECT AR � r
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application