17-102196 RECEIVED PERMIT APPLICATION
CITY OF 4.....,.
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MAY 1 t 2017 PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CIN OF FEDERAL WAY
C01 M 0 'DEVE( 1�
PERMIT NUMBER
- - TARGET DATE
SITE ADDRESS SUITE/UNIT#
33320 $ r(6 Hy \s> /D/
PROJECT VALUATIO& ZONING ASSESSOR'S TAX/PARCEL#
$ i 9 d Z 0 _ 0 O25
i
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING LJ(TIRE PREVENTION
NAME OF PROJECT ye) /
V I
PROJECT DESCRIPTION .{.�I 57.,:p 24--76n1/
Detailed description of work to ���e `tw be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP //d
PHONE 5(/07.
NAME I A7 7-11 N`l Palk),
/' /.✓
MAILING ADDRESS . / E-MAIL
CONTRACTOR Fib ° J� / G1— /7I�� 504 ie
CI Y 1wW�//n///� /y��i— STATE ZIP/{/�/��`/�3•//j FAX
WA ST CONTRACTO 'S LIC NS # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME �� PRIMARY PHONE
APPLICANT MAILING ADDRESS ea
MAILING E-MAIL
CITY — STATE ZIP FAX
NAME `��'f lir PHO.J��t�
PROJECT CONTACT \ / iat-ej. ft ci �G" '����1 /5�9
respond
individual to receive and MAILING �ES® )( p f�
respond to all correspondence ,� � �I
concerning this application) CITY ' IST�TE zlyti`,I 77 FAX
NAME ►1 IL W L3
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 out of the reliance of the city, including 'ts officers and employees, upon the accuracy of the
information supplied to t .'ty as a part of this applic.tion.
SIGNATURE: ,�I Allir ArAilligli DATE ___k—r-1/ .....'
PRINT NAME: Ail J71/Ifs i , //-
'Ws Fr- •
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 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
TITSHWAST-TERS RAINWATER SYSTEMS IIRTNAT,S OTHER lllogcr;ho)
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
I $
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 I TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
................................................................................................................................................................................................
DECK
...............................................................................................................................................................................................
GARAGE ❑ CARPORT ❑
................................................................................................................................................................................................
OTHER(describe)
................................................................................................................................................................................................
EXISTING PROPOSED TOTAL
1 Area Totals
**NEW HOMES ONLY** 0
[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 m Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application