11-100753 • •
CITY Fe PERMIT
FeCEI\J SF MF CO ME PL DE EN FP
COMMUNITY DEVELOP RVICES AP P L I C AT I O N
253-835-2607•FAX 253-835-2609
www.cituo((ederalwau.com 'EB 2 4 MI `�
SITE ADD pf
FE AL W SUITE/UNIT#
:),Lke,"Y" 5-' cbS4 Ai{ .)
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ /CW) 9 SO4 5 I _ 0 0 20
TYPE OF PERMIT ❑BUILDING ElPLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) ,_,..‘ fia„ .... /pie 066,.._.0., /4,6/ . bo.;:i ....5-7z.e, ?ye
PROJECT DESCRIPTION l� i-/-
Detailed description of work to L ,C t j ,r IC( J
be included on this permit only
N PRIMARY PHONE
PROPERTY OWNER 1- h (v�I ll
mAj'4 5 J 5 9 /J 4/(`D
� E-MAIL
CITY `a</. - A(,{/GJ(l `.��� Alt- LOA STATE ZIP/2
7 —i
NAME „.i�i./�, /4 ��'1 5 ��� 1-
MAILING
PHONE J D . 72
MAILINNJGG ADDRESS ( /f E-MAIL
CONTRACTOR : c 1-r0- -1:2V ,�✓. J. C e/ C� //�Slr "7/J7I
CITY STATE ZIP, r FAX ix/6,A
cof. WA STATE CONTRACTOR'S LICENSE#'a.-61/
/`,v EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
L t1 2 Li / / V� :/'—/,�L
NAME PHONE
MAILING ADDRESS 1 E-MAIL
APPLICANT AA
CITY STATE ZIP /�� „L.: -rye
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) 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 a part of this application. /
SIGNATURE:G -�� / ✓ DATE G�-
PRINT NAME: /4/7/ /((( / 'I i7 'f- -"'c
Bulletin#100—January I,2011 Page 1 of 3 k/tHandouts\Pennit Application
• •
�/'� �! I1
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 riot include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLI:IS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES 3: ' F ,,3
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 mb/Shower combo) LAYS(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 c No ❑Yes ❑ 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 ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
''- COMMERCIAL==x N A IT1 '..
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS O'',
AREA DESCRIPTION
AreaConstructionGroup(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:AHandouts\Permit Application