11-105036 / - / as D3 �
HERMIT F �o
tart D '•Federal WayCOMMUNITY DEVELOPMENT SERC DD I' • LIGATION , RERP
253-835-2607.FAX 253-835-2.:
,, ��c fir iS--� m_ i DEC 2 2 2011
SITE ADDRESS IZ OF Td!D A l WAY
��0e Yej&7‘ \ CDS /�(_ v�/
PROJECT VALUATION ZONING ASSESSOR'S TAX/••RCEL#
$ \0 ' O0 -
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ElCHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT `
))))
(Tenant Name/Homeowner Last Name) \i.
ALA)` ) <, A P� T �j,
PROJECT DESCRIPTION �� 1� � 7 j'`�>C. cAVA J 1 Lj.\C \
1 b v(\(\ i-)�
Detailed description of work to
be included on this permit only
NAME PRIMARY P O E
PROPERTY OWNER v '\
\W%3 U� \\t ke \ �S'3-- L�_Q
) V S \ eA0 k• VI\J1 S.. `J `0 E-MAIL
IVLAILI
C STAT
FJ ZIP 1
�� Sl1L1r �yw
NAME - , PHONE
MAILIN RESS E-MAIL
CONTRACTOR \D V`C I4 ' . J
CITY-gATATE ZIP FAX
WA STATE CONT CTOR'S LICENSE# EXPIRATION DAT FEDERAL WAY BUSINESS LICENSE#
NAME ( I / / P`
Wk\ C11\ hn C::).b.)
APPLICANT MAILING AD RESS 1 , ^ E-MAIL
5k OrC A \NANO
1UC _ ZIP L l Ly) FAX 113--1 s5
PROJECT CONTACT NAME �\ �� �',� 1� Pa —V
1)
(The individual to receive and (. - v19 Off! ~��C
respond to all correspondence •
MAILING ADDRESS \ E-MAIL (� (�/y
concerning this application) �1\ � L C \J g - `� ,-)Se (1 ` V.)141"\\(((����
CITY()MAC)1 STATEUOIA
ZIP C 1-I
( FAX U CNN((),(0-1.4\
ALTERNATE CONTACT N E: PHONE VVV E-MAIL
nt
PROJECT FINANCING NAME ❑
OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.2 7.095) 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 I.ws.
I further agree to hold h•rml,\s the tty of 'ederal Way as to any claim(including costs, expenses, and attorneys'fee- incurred in
the investigation and defen - of •ch cla; ), ich may be made by any person,including the undersigned, a d filed aga st the city,
but only where such claim • "ses out oIth- reliance of the city, including its officers and employees, up n the ac racy of the
information supplied to the as , part • t is application.
'0\ . - ) \
SIGNATURE: Ali
�k\ ila DATE
PRINT NAME: MIL 1 �1. • ��
Bulletin 4100–January 1,2011 _, 1 of 3 k:AHand. is\Permit Application
• •
x
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
? _ ,4.,- . � ., a_ « ,.�., 7 s ..�"3, »�. ,a_. _.��._,. _�» ,.. ,�� ��' Imo• .... .-_
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) TOILElb WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/utility) WATER HEATERS(electr(c)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
IN.robiiMATIOi' AGR
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?
C7 Yes ❑ No ❑Yes ❑ No
,. _ SID"r'i�'(� .�z
•sii �'i :E UI I11 r E 32.. '-'S c 2,,..
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
•
I3A4`+'IVIpNTi
� .x •, s . .,• x ,� . ..Viz. .
FIRST FLOOR(or Mobile Home)
$ COND FLOOR u " ,, ,
;
COVERED ENTRY
{{ c6
:'s;1 .a,,;�:,t #a>z�' `, kz�5.°i•' t, r. -��*a%i, '.�': _,.. _s .v a 3'�'sr ,>, 'r _.._...--_.- --.--_._.._._. _._..___....__.-- _.__----_—.___.
GARAGE Li CARPORT LI
t 'SCrIbL_., ' s '
EXISTING PROPOSED TOTAL
Area Totals
**NEWHOMES°ONLY** '0a .
ESTIMATED SELLING PRICE$ ___ _ qx7� # OF BEDROOMS
s s ;: a..
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
NEW BUILDING •
-
ADDITION
COMMERCIAL
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin/4100—January I,2011 Page 2 of 3 k:\Bandouts\Permit Application