12-101949 21/4. _L 0
CITY OF ` •PERMIT •
Federal Way • ik�°��T�
COMMUNITY DEVELOPMENT SERVICES APPLICATION FLS 1)
253-835-2607•FAX 253-835-2609
u'?care.eitlgffe±iernfwau.corn.. MAY 0 'L 2012
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SITE ADDRESS OF F At. WAY
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CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARC � � � -
Q 1—
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT —
(Tenant Name/Homeowner Last Name) V •
F\ I1N' y -b 1_)
44,4 r .. 4i -�r-,z,;
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
PHONE
NAME ^
L.vi�/ 1. ( .
MAILING ADDRESS —, E-MAIL
CONTRACTOR G✓ �� S ,�
CITY (` STNIT ZIP / FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ln/j_ w t� i. (�` e. f, /
NAME ,�- PHONE
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APPLICANT MAILING ADDRESS J �? E-MAIL
r ' .- 'L l'
CITY STA ZIP FAX
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
ALJ pq
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 arty 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: DATE
PRINT NAME:
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
�.: .4ffyit-
VALUE OF MECHANICAL WORK $. (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTU' D.:t
gF4P7Frnnr,Z,MVASrj:Pgt%SlrrOYANTaitiEiag:rgatZMRE:7AVS:4'p,':fIkp -SF..VWAWFITWCftV,rtkfi,,r7prrjffr,, ;7.,7
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes ❑ No
xr '`!'•.•!;4.1-n Tm . ,,� 6
'�Md",Y,w:bffs.,l,,.,t am,�B v g, �� � ^' o.f^ ' �� ....,. �.,�� �. ...� � .;c "`�" - 4t: 144:'',1-04:54WMA
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
I
FIRST FLOOR(or Mobile Home)
r
COVERED ENTRY
GARAGE D CARPORT ❑
I r s
sem'' .V441,7
Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
In Square Feet Type Stories
r s
0 i s �'�'ja y
ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in S•uare Feet •e Stories
P,� # � I ,.. _
TENANT AREA ONLY
T AREA'ONLY �a 6 r s
mo, igtre
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application