12-100045 o oc
der W ERMIT 1F CO ME PL DE ENS
Federal VV
COMMUNITY DEVEIAPME1VT SERVICES k 0 4ApP LI CAT I O N
J
253-835-2607•FAX 253-835-2609
www.cittioffederaiwatt.com
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F �`L\1U AY
SITE ADDRESSS � � SUITE/UNIT#
1 RAC AC, l 1 141k)�y CAWA CA t
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ Ia11-1(00 � — — — —
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
NAME OF PROJECT fl-0076
1
(Tenant Name/Homeowner Last Name) FK' `/b^1 ( fit9 Q h4 Toa L3 3V e vl---
PROJECT DESCRIPTION ,� n
De .lied description of work to 1 1 re Y ‘Rtk) f 1 Y`(' Pyr Yr1 1 /
be included on this permit only N ec I 1 e 5\isk )
PHONIC
PROPERTY OWNER xn>,� N *n Cti.1 N 1-1 uk( I es Y1— (Q 5 0---u s6
MAILING ADDRESS - - - E-MAIL
CITYJ STAIR
0 r ,nCiko FL- �5o I
' proI, 'C� Ca bit, ` -( - 'l/3
CONTRACTOR
MAILING ADDRESS-7(0 I 1 j 0 4in CA- .k- er-.Pro b s+e Uc ai
CITY I�etn S�.i�� 13 Z FAX 1-05-41510'` r7 i1-1 �C'`y
W T TE NT R'S CENSE EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
` -e` , W 0 I a�, i3 19 -9g-10 -ss-r7NAME _-C?O-13 j-
Pfo-Vec-4 cxi C)n-e 0517— 113 0
APPLICANT MAILINSif
0*
r-e x1P bssepid/e�c t ►Un',
CITY `+ ST/LA ZIP
qO/ JC_V Sir-1 (uwt
-!J
PROJECT CONTACT NAME rV y PHO
Z) to _ I
(The individual to receive and �,,Q
respond to all correspondence MAILIN�G7 tADDRESS W r IV �°C �7GK L
concerning this application) l v 11 S O " "�"1gsig I
CITYIUC./ 6' W I' 1 F�W
ALTERNA E ONT CT NAME: PHONE
l lrye r\e r 97T-01-1100 11174-be ra r►e re Pe u•rn,c
PROJECT FINANCING NAME ( i� + `�
l ) OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE, PHONE
j(c V4 I oro► 4C( i C cJct6 odic 913 g0,5---3&8--1 00 d
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 clai arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to ty as a part of this applicatio
SIGNATURE: ( (�N►Vl/a,,� r- DATE I
PRINT NAME: Y 1 r'� ► to 1'` .
A
• i
CAL'F .
VALUE of MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offt,cture to be installed or relocated as part of this project. Do not inclI,th'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
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) TOILbab 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 ORIN?1AgrION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EX STING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
(") i 3
8 Pr
XYes ❑ No ❑Yes ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DRC ' '
GARAGE 0 CARPORT 0
OTHER(describe) `
EXISTING PROPOSED TOTAI.
Area Totals
•* HOMES Ir,**
ESTIMATED SELLING PRICE$ {#OF BEDROOMS
AREA DESCRIPTION Area
Group(s) Construction #of Additional Information
In Square Feet Type Stories
NEW BUILAINti
•
ADDITION (('� �*eyt (] MotittiT�vr�Y
AREA DESCRIPTIO
N Area Occupancy Groups) Construction #of Additional Information
in Sc) T
ua`re Feet } ype Stories
TENANT AREA ONLY
PROJECT AREA ONLY