15-105498 __ _ RECOV ED •
CITY 0 4 PERMIT APPLICATION
Federal Way OCT 2 8 2015
CITY Or �
FFEDDDEERAAL WAY
PERE=NOMBEL J 5 _ I V, J -/ 1
- a
TARGET DATE
SITE ADDRESS SUITE/UNIT#
01 3 00 ?A—CI FTC E-11iv A r s 5173 t
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1rN
1 lel_ Co a -7 a q 9 - o a a o
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING tad FIRE PREVENTION
NAME OF PROJECT DAu't-r A C Ll N=G
PROJECT DESCRIPTION
2f Mu DEA of ExzS?TIu4 at�LLQziut. FU IL
Detailed description of work to CLT++-►1..• IJ f L ) lk 11. fi S S A f jL f. F Tg E (-A La(24V\
be included on this permit only S Y S I.M -
NAME PRIMARY
PROPERTY OWNER PHONE
)M A R< , VC-A fL,L
MAILING ADDRESS al _s ForafaA A uE 50 t 2.14 E-IKAIL
CITY STATE
S ri ATT LG (Ai A ZIP GIB F i Co
NAME PHONE
PACIFIC- LZ v j- E E}J1tG4 LLC.. 253 191-O'i'►a
MAILING ADDRESS EMAIL 1 p
o
CONTRACTOR ?i E LetS4 133(x) 3OTMEu EUEaCTt Hwy rt q—mayAe.rdCosv CST./'1 Li
CITY STATE ZIP FAX
1Y\SAL L(2-EsrL L,.IA Q$oI2 avl, 8a9-X42.1
WA STATE CONTRACTOR'S LICENSE A EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE i
I?AczF LE 89 0 Li-1 O.-Li 1)8 /owl o)O-I4- I O 1400--c)J4 L
NAME PRIMARY PHONE
SplTv1 AS PrIle,uT
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAMEPRIMARY PHONE
PROJECT CONTACT 'OIJ LYN AyN P 2 P 01.3 -IS-1- a 4-7t1
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 1'M S L..i S 4 t�V14€l L E'b EQF T T (-41.4-) i rOi -MC,y A4rcl B Gon�cwsl. �•rCf
concerning this application) CITYST p ZIPFAXI2
FAX
CY\w..IL CAE 5-1C-PROJECT FINANCING NAME 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 authorised 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: goy\ k-V\ DATE (b -Z 3-IS
PRINT NAME: 'Raimo M Ay M A•2C)
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• •
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(commewal)
BOILERS FURNACES HOT WATER TANKS(c$
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS)or Tub/shower Combo) LAVS)Rona sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/uhvty) WATER HEATERS(prerhio)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
g0 Lutn LU 1, 01 ,000
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
CA; ; ' 3 14143/3 ❑Yes Iv No oil Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
'*
•454.W: r- _=^-"¢a :-#' s }� .x s
xkth z er "�, �uN`, i,° ,;�.-..ugag-
FIRST FLOOR(or Mobile Home)
✓ ti `s `#.,: -`�"t "5 s €✓'.a' a zr___.—_._ �....d.—__ .._._..._ .�._
,c
i �` ili wra,rr. .tx,k40, .>. E ,.c'� r„-?;6e 4-4."iA ..—_......�_._.....�..�.____---^
COVERED ENTRY
,t�±" f'�'". €a s'FA's ��'-�'�" �''� r€�``�'?�'.�, t ^ssq,� �.Y''�< t
# ' "''< wr 7 <... aur .,�. 'rg ter
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GARAGE D CARPORT 0
Area Totals a .,TA,
Ms51,1FVEVON-45: 1,1, z;
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in =ware Feet Stories
y�d ��� �,w r#$;t,S„ � � • r k? �� , ,s^' rc � `.^���" � �' n ;{��✓ �� ��""a .
rsf s ,._, �,. ..,�<n,,��t;,..�>"�.-<r,�,�� ,�,s,$�;, '�..,, a='?4`��.i.»~�s=,.F Jam,��.�c...�. ,:,.,��.6�«t- :z? �:::`�'� r�s;!v;a�Wit, ,"� s, .�..,,. _ 'r;�..� ? .,s '�3�,.��.'„rr�GC,
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy OTonp(s) Construction #of � �Information
in Square Feet Sto�s
^� .^7`;-.. i "'=4" qy^ �. .�?t �a�r, ,.e
,.3ika:,,.�,[ .x."s?�'6,...-.�,,,. �,• '�:, ...,r�..s.�,.,�.'ta,a:�a":e�W ,. :�,a'.'�,,'%�,��Erm.�,..:,'�a'�,'�',< .. .4'::'i�r� ar�;��F. t,�,� <. ,r,f'`��`7��' �" '-sF�^'*.�. :>
TENANT AREA ONLY
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Bulletin#100—January 1,2013 Page 2 of 3 k:111andouts\Permit Application