12-101727 141°.
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Federal W
I'ERMITay S F CO ME PL DE EN 8
COMMUNITY DEV OPM NTS, b7 s E6PPLICATION
253-835-2607 V
SITE ADDRESS APR 18 2 u 12 SUITE/UNIT#
(�T tr r I � _ ��w�( • s Dc�a L w r� I 3
pg�il$ AD�AG+N � rl�+SY ASSESSOR'S TAX/PARCEL# 7
$ .___EDS Q G 2 l 0 4 - 9 0 4- O
TYPE OF PERMIT ❑ BUILDING CIPLUMBING ElMECHANICAL
❑ DEMOLITION El ENGINEERING CI-FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) I G 01 1'I O I T H 0> — Lr
L, �✓I 1
PROJECT DESCRIPTION Av D i 1 / /40r.,. 5� o b_ ,, m b 1/t / fi et r Al .�fC O t_ .4.k.A-
Detailed description of work to ?vto _rtl7,t:O n
be included on this permit only
NAME ,,(�,, t- ff PRIMARY PHONE
PROPERTY OWNER SIA ht ctxs- - -Koff t we-cf rAf- .1 C kuiti h ,..)_s-3)3(f-' 1 — / 0 --
MAIL G ADDRESS, E-MAIL
CITY STATE ZIP
NAMES,` PHONE
1a1
MAILING ADDRESSn E-MAIL L
CONTRACTOR 11+C D-rt �ieT wt[C'r 4 3 b C .�Lt-Lt (3Arrj�� Ole."
CITY STATE ZIP / FAX
1
/
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAYBUSINESS LICENSE#
,. * 1 n,, 1 / t / — ' / C
NAME PHONE
S14 ti1 • .43) S90 — 3`°.-2
APPLICANT MAILING ADDRESS \E-MAIL
n alk-- s-r L'c-r-t -,t3
CITY STATE ZIP �ppc ` FAX
PROJECT CONTACT NAME ' PHON �)
(The individual to receive and a�<<. (6- 1(.041 Q� � 3 3 L 33'�
respond to all correspondence MAILING ADDRESS / E-MAIL g{�
concerning this application) no-06 a-i)t" yT WEsf 4-3bO 'at KA eProted hIur.CCO
CITY STATEZIP FAX
ALTERNATE C NTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
Ei OWNER-FINANCED
Required value of$5,000 or more
(RCW 79.27.095) 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 • part . this application.
I .
SIGNATURE: DATE I''/ 9 , (ation'1/4
is NAME: <-7ft S ! I i
Bulletin#100—January 1,2011 Page 1 of3 k/Handouts\Permit Application
V,- , *-1e1• , • " _
igt,,,,‘V,; :,fg: siAk. • 1)‘-t:kJ RES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture 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
7751,71.71,,,,g5p,
"•&•;litia2t,tt: gilt; 2
Indicate how many of each type offocture 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 FIXTOREti==.1:.
, = ORNIATION ".' - . '1-"'•1=
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?
o Yes CI No Li Yes o No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
. zt4';'44,414';', .M4:4.4.
1;7- •tlf .11<5:
. . .
FIRST FLOOR(or Mobile Home)
NDFLOOR441141;;;2.
COVERED ENTRY
GARAGE LI CARPORT ID
OTHER-(deserthey - ;
EXISTING PROPOSED TOTAL
Area Totals
* NEWHOS ONLY •
ESTIMATED SELLING PRICE$ #OF BEDROOMS
Area Construction # of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
' ' irt`.12r4n,
ADDITION
„ , „
4,15.Afie -14krae,
IODFLL/TF N ANT illPVFNIEN
• - _ _ _ ../404-vc.
Area Construction # of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in S.uare Feet .e Stories
1(1) I. BUILDOMA
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application