16-105438 '`'��►„ • PERMIIAPPLICATION
CITY OF
Federal Way RECEIVED
PERMIT NUMBER 8 W C 0 543_8 NOV 14 2016
SL <— _� �— L '✓ TARGET DATE
CITY Oh FEDLRAL WAY
SITE ADDRESS SUITE)#
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PROJECT VALUATION Z9NING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING AFIRE PREVENTION
NAME OF PROJECT i„� 1�1)q j
PROJECT DESCRIPTION to.t. 1( t- 7 A/ Vel-oj� ri ce AI Ji[M system
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ttar cf1 1-viVe-Sf(/vl�t�l-1"S l p(? --'tc
MAILING ADDRESS I E-MAIL
PO 130X. 2:77C6
CITYS ZIP
1?)( -I& O
cA O . 87705
NAME „,,..ealC 0 v b 1 PHONE X25 3 I'72�l
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MAILING ADDRESS E-MAIL
CONTRACTOR - _ 4(003 SUvi
CITY / STAT ZIP FAX
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WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
'aCO -1111/P6)
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NAME�I O ` �J Jit v6O v 1 SL-a'4V vi7I PRIMARY 7
APPLICANT MAILING ADDRESS E-MAIL
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CITY STATE ZIP ,/ , FAX
CITY,-
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NAME-T-Foy
-'� C PRIM��A�RR^^Y PHONE
PROJECT CONTACT I I oy S lel nst 1� 11 26 3/ 7124U
(The individual to receive and MAILING ADDSS + / E-MAIL
respond to all correspondence 30161 W 140/-/- kve
concerning this application) CITY ---` ���e�� STATE, zln � i FAX
\AINAME V 1
PROJECT FINANCING ❑ 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,ylq of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplieded t -eify as • •art of this application.
' /
SIGNATURE: - :i1411111111-'1111 DATE I I— l �
i ((�)
PRINT NAM Cr i
Bulletin#100—February 22,2016 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 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(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(Kana 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
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-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—February 22,2016 Page 2 of 2 k:\l-Iandouts\Permit Application