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12-100198 CITY OF I'ER M IT Federal Wad/ StMF CO ME PL DE EN FP COMMU.V7TDE LOPM NT.516I ES APPLICATION .ECEIVED JAN Y 3 1-$i SITE ADDRESS . J 11_1 (. S `I ' 4 ` N V _ ...0 JAN FEDI '3 13 2 p c 1 --' t` \-; L,:,-L S. IlYk1.9 IIDc �Qk Z 7 6 C. PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# M�J 1� 4 Sc ---o TYPE OF PERMIT LIBUILDING IIIPLUMBING ❑ ECHANICAL El DEMOLITION ❑ ENGINEERING 67 FIRE PREVENTION NAME OF PROJECT \( r �/. (Tenant Name/Homeowner Last Name) B-�'� V L+^ `- 1\r0-De PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY STATE ZIP NAME PHONE MAILING ADDRESS E-MAIL CONTRACTOR `> LI N `- `c U �x <I�fj C Cp l�(b t G n, CITYS e4 4 I � STATE-LZIP � k • L FAX WA STATECONTRACTOR'SCONTRRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# ..e. CO NAMELD fl-1�S ����] � a� �� / / - PHONE S APPLICANT \ MAILING ADDRESS KK nn E-MAIL CITY STATE ZIP FAX S ala--tZ. PROJECT CONTACT NAME q,. p PHONE (The individual to receive and 5 (\, respond to all correspondence MAILING ADDRESS E-MAIL concerning this application) CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME 111 OWNER-FINANCED Required value of$5,000 or more (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE 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: _ Z - DATE f 1, 1 12o > Z PRINT NAME: 1k-‘91° - -__-__<„,_ — Bulletin#100—January 1,'1011 Page 1 of 3 k:\Handouts\Permit Application • • ` 1�''.1ECIi NICAL FIXTU4,4S,FIXTURES VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided) 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 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 Mand 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 TOTALI`tLTVRE :.:; GENERA L 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 o No t:4 o- , # �� 4y G'..• �t � ffiq�� _'s. F«,,..o �..e .���.�'V.,...L.e:� :Ct.s. ..,ac.�. c;f f . AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE TEASEIvIEN �a f }.. ,, v. ; "L<Y FIRST FLOOR (or Mobile Home) CND FLOOR T-e COVERED ENTRY GARAGE ❑ CARPORT ❑ 11,143ER(describe) EXISTIN(: PAOPOSE� TOTAL — — Area Totals **NEW HOMES ONLY** f ESTIMATED SELLING PRICE$ _ # OF BEDROOMS COQ MERCIAL—NEw/ADDITIt3N AREA DESCRIPTION Area Construction # of Occupancy Group(s) Additional Information in Square Feet Type Stories NEW BUILDING = ADDITION ;�i�{y;.gyp -((���(Y}�� {�y��[ fj�']�'L�'}� (}� yfi C u< CONI AX.. CIAL 7AIi AIOI)-i:f l.:.1 E SANT 1141PRO VEMENTS AREA DESCRIPTION Area Occupancy Groups) Construction # of Additional Information in Square Feet ' .e Stories , TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100-January 1,2011 Parc 2 of 3 k:Ailandouts\Permit Application