16-102779 `
CITY OF • PERMITtPPL1 ATION
tl V k:L
Federal Way
JUN a 7 2016
PERMIT NUMBER ((.0 (_ 02 / _ TARGET DAT ITY OF FEDERAL WAY
- - CDS
SITE ADDRESS SUITE/UNIT#
3/l i )a /
PROJECT VALUATION ZONING ASS SOWS TAX/PARCEL#
$ / ems, 0CI' 1 0e _ 9292
TYPE OF PERMIT D BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING RE PREVENTION
NAME OF PROJECT 48/ a4,119
J a ,j,7� ��r� 'may
// � f'I rc! iiJJ
PROJECT DESCRIPTION • y�� ��/
Detailed description of work to P r4(7 ( // /r 4 1�i�a --ju�/-J�a
be included on this permit only / V
nd/
- NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
/?6 4-Si, 4/
0-iff-' Y
MAILING ADDRESS �� r MAIL
CONTRACTOR _-5fixc.4(,))to
CITY /� STATE ZI /�/ FAX
WA STATE CONTRA 'S LICENSE -.. -� TION DATE FEDERAL WAY BUSINESS LICENSE#
'---C.5-1 Iii F /,e06-)
� mit
NAME PRIMARY
MAILING DRESS rip E-MAIL �� -----�
APPLICANT 0cRc2 e 40:pcer/ .4) 091
CITY / K- u
/
re
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS C E-MAIL
respond to all correspondenceO a e_.
concerning this application) CITY STATE ZIP FAX
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 ma•- by any person,including the undersigned,and filed against the city,
but only where such claim arises out of the reliance of • ci,, eluding its officers and employees, upon the accuracy of the
information supplied 'the city as a •• • t is appiica 1• /
SIGNATU' �� DATE 6_-_.7r----/�
PRINT N' A : I i kt-► AO / 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(Gas)
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/Uti ity) WATER HEATERS(Electro)
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 D 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)
Area Totals EXISTING PROPOSED TOTAL
**NET HOMES ONLY"*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area m 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 FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—February 22,2016 Page 2 of 2 k:\Handouts\Permit Application