09-103392IPI RECEIVED - � � �.
Fe �'E R M I T SF CO ME EL PL DE EN/r
Federal Way SEP 0 1 "''
PT TCATIOIIT / /
COM..':PJi fY DEVELOPMENT SERVICES ■ ■
153-835-2607•FAX 253-835-2609 fA.Y1�i1/'�1'1(y•F
www.cituoffederalwau.com r� FEDERAL !
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errs ADi Y
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SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
NAME OF PROJECT A \\
(Tenant or Homeowner Name) ., `\c'`C�-c(2J+ ter. V --(---k--- Ot 0
0 BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT •
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING IRE PREVENTION
S-C�& - V -r'V- -k.--.7: /7/ Sc.- /V '_ /- --- C 7
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER \A til) V`C_.ICA— -: ( ) -
MAILING ADDRESS,CITY,STA ZX9n�
'ID�LtP E-MAIL
OWNER IS ALSO: ❑ CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
lei
Ci r-'A F "L„ttAti�Z.,L-G. (de.4 le!-S bC`e'e34-0 Cr
CONTRACTOR MAILINGec�ADDRESS,CITY,STATE,ZIP / FAX
'C ' , i/_ j` I4W4t' •014--- 16617 ( ) _
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 8
(t1/ .Z.- 2' 5T /_ -"C"/ie, gL- 22—
NAME PRIMARY PHONE
APPLICANT ( ) -
MAILING ADDRESS,CITY,STATE,ZIP FAX
( ) -
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and (.' & ) 1t/-,::,-- C t° .,1-/cry
respond to all correspondence AWLING ADDRESS,CITY,STATE,ZIPFAX
concerning this application) „rsA e 71/6 ie. -4.�` 1/4—ci .T- ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
-•>-v ,- M'ki`1-c_:.) ( ', ),E- t tO3 SC‘ '‘i Jk.ecl-e:SCiaci QACt.
PROJECT FINANCING NAME de,W
❑ OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
IRCW 19.27.095) ( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by arty person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
._ C
SIGNATURE: , �efi� k. DATE ' 6 l
PRINT NAME: 6.--r— `C- `5) VL
Bulletin#100-4/17/2009 Page 1 of 4 k:J-landouts\Permit Application
• MECHANICAL FIXTU
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) a
Indicate number 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
PUJ BII 'IXTU ES
Indicate number 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/ShouerCombo) 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 FIXTURES
--
GENERAL INFORMATION
PR• VALUATION \ WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
a 0 a I O/'-/i •t TSE LOT SIZE)Ia Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑ Yes ❑ No
RESIDENTIAL
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 El
OTHER(describe)
EXISTING PROPOSED TOTAL
_ —— -- --
Area Totals
**NEW HOMES ONLY*"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS h,t
AREA DESCRIPTION Area Construction # of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\I-Iandouts\Permit Application