13-104732 S
,,,, 4114 IP
PERMIT APPLICATION
Federal Way RECEIVED
PERMIT NUMBER ( .� / Q g 73 OCT 2 4 2013
TARGET DATE
CI I Y OF FEDERAL WAY
SITE ADDRESS SUITS/uNI€OS
300201 EFIACiAid CPC,zk S ccc _
PROJECT VALUATION ZONING ASSES R'S TAIL/PARCEL
$ 2q2 t O L( - 1 ? to
TYPE OF PERMIT ❑BUILDING 0 PLUMBING ❑MECHANICAL 0 DEMOLITION 0 ENGINEERING LT2•YRE PREVENTION
NAME OF PROJECT j kt fav S a ,L a 1%.iGfti
,
pc.?Pcl ( �C ce pg rre e_ reit edni-ra pang(
t44, game_PROJECT UEscRPrION
Detailed description of work to A^-jel-G1 leni 644 51',2CXh• ltrAeLk'eA4 ext4cnn3
(^ MCPJ .
be included on this permit only
NAMEPRIMARY PHONE
PROPERTY OWNER E r, n j ?CrrV5 r�-+1[:..
MAILING ADDRESSE-MAIL
p.6. l
CITY L.rL.t.ttrA,s
TY. 7
NE
NAME \A- (( % Alm L. h`SZt 3?_25
MAILINGPort- r
CONTRACTOR \' 5' A M ttot. tailor 7I7>e
CITY
5
I Y5 � n Z ZIP
R613t-1 F' 6"322-`72ti
WA STATE CONTRACTOR'S LICENSE* WIRATION DATE ger..DERAL WAY BUSINESS LICEitsz A
NAME PRIMARY PHONE
Sane as CDA
APPLICANT MAILING ADDRESs........... E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY
PROJECT CONTACT - MC Ii ',1�
1"I[J� 20 6)- CC",SIg1S
(The individual to receive and
MAILING ADP-4030
r MAI t
respond to alt correspondence �+11J0 A�rDf►(� ( jV�1Y t wart Wt6kos61c1E/...p
concerning this application) c� [_ ATE ZIP FAX
Sec rnf..� wA C$t3L( VAD-327.- l 4
PROJECT FINANCING NAME 0 OWNER-FIIIANCED
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 thecityas a part of this application. A
SIGNATURE: ..,. .../.7;•-•• ••/ � _
Marl(' C-I DATE //"l t/a��
PRINT NAME: Mi <
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• I
VALUE UE OF MECHANICAL WORK
MECHANICAL PERMIT
indicate how met/Igo/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(commercia4
BOILERS FURNACES HOT WATER TANKS;cam
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 rvb/stm ve com et I.AVS(Hand sinks; TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS i taken/urine, WATER HEATERS(Etert,ic)
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 CI No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**11W HONES ONLY**
ESTIMATED SELLING PRICEw #OF BEDROOMS,—
COMMERCIAL-NEW/ADDITION
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
In Square FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area Construction i«of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feeta Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application