17-101818 RECEIVED
PERMIT APPLICATION
CITY OF
APR 21 2017
PERMIT CENTER. +33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAYS
COMMUNITY DEVFLOPMEM" r '---/���
PERMIT NUMBER 1 1 -. 0 ' F 1 8 - 1 1 TARGET DATE l v I I I
SITE ADDRESSSUITE/UNIT#
3z PP-c, F,c 1-/. 1Wgy
PROJECT VALUATION ZONING 9 ASSESSOR'S TAX/PARCEL#
$ av,00a oo CG _ 1 5 0 0 5 C _ O 1 ) 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING I,$FIRE PREVENTION
NAME OF PROJECT A,c 14 - F, - - F
PROJECT DESCRIPTION Mit tr e R i 40 v.vt� Fe c 4/N C
Detailed description of work to
be included on this permit only
NAME ' PRIMARY PHONE
14 P-e5ht- i N v --S i vt l S
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
_ �
NAME .... PHONE ..
$IZ/ck 1.411-#b a- So.vS 360 - P2q 6777
MAILING ADDRESS E-MAIL a&MOo1 ' Co Al
CONTRACTOR F O Sax / o SR1YR1'e&t•S4ul'g ) A
CITY STATE ZIP FAX
13vck44% WA- 9'S.3c7 (31o)oZ1 -6v2�
WA STATE CONTRACTO S LICENSE if EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE It
ST i-e k se eki a 8 / / ,,20 N/ob 41v-aa-in
NAME PRIMARY PHONE
gni ic 4 14m 1) a.- 50 VS 000 /50 - P7 Y"
APPLICANT- MAILING ADDRESS E-MAIL O V GO/I('•C p 41
P. 0 130x / C) S4}lv..hRf. 5444)SL) A
CITY STATE ZIP FAX
etickl=e y WA- P 3¢"7 No) pg - 02;
NAME PRIMARY PHONE
PROJECT CONTACT 514-1. • Ale L to (Ao4) 4v 0 `,9 7Y1
(The individual to receive and MAILING ADDRESS E-MAIL p vt'!_po is• C oh
respond to all correspondence P 0 BOX' /0 S ALV4 feO f,S4vb c 2
concerning this application) CITY ^ STATE ZIP FAX
✓SvC421 7 pv.4- ' 3 S 7 (3‘,) g29 - 6 yes.
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$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 the city as a part of this application.
1Q1 �
SIGNATURE: . P
' D. 044.41/4
44.G/" DATE t V-21- /7
PRINT NAME: C✓Kt. • pti e LL?
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed or relocated as pa.t 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(coo)
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 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 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 ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
,firi1„w"� irrr ��;. ! ry�y ':.f ✓ r' f ',u�`!r ;i r 3` _.__............:.........._.._._:.........................................._........_......._.._..........__..._.._._............._. ._
�� : t , sr' �' fFf`s� ; J fr r 4, s' iri &,P X,'V ri/444-`.r r v?
FIRST FLOOR for Mobile Home)
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f '; ,, 1 l s117, f401X ur. ,.'+ fl✓ r#Yy
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= .v ,�
COVERED ENTRY
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Y%:,�Y# '`, 4v, ir'iri.1,4� f./s uzf .F`� rf../,.:.;:.,. rk......,:/s,'.X: .,%rf,w',-`'� J2'.. '�`,uv ''s` o'v;....._......................_.........................----............._._.................._..............___...._______..........._.........__.........
GARAGE 0 CARPORT 0
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rir` r f. z rr,r
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"..__............_.............---..........................................................._...................------._..__.............._..- -
EXISTING PROPOSED TOTAL
Area Totals
,rrkJplrr O1„ '�P J4„,h% ,rsr ,a�� ; „0w
f:�J
ESTIMATED SELLING PRICE$ #OF BEDROOMS
I _.
COMMERCIAL—NEW/ADDITION
Area in " f Construction ,�. #ofAREA DESCRIPTION Occupancy Group(s)
Additional In
forf,r%.mati
Square Feet Type Stories
rr ' y; rr ,, iA', ; � % � /'
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ADDITION I
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION
,•i,.. ,rU .f,rrF,,r „. Occupancy
ancy G".:roup(s)
Additional Informa
tion Square Feet -, Type _Stories_
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r-;7@ ,.teyr' F` ;rf„� , ,, .. r7, r� r. r0 / ;�/*401r *ijaktr //32f-49
TENANT AREA ONLY
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application