12-103191 RECEIVED - - - - 1
OPERMI'T
CmTy OF
Federal Way
MF CO ME PL DE EN
COMMUNITY DEVELOPMENT sF -�1 112012
APPLICATION
253-835-2607.Fol 253-835-2609
OF FEDERAL WAY 1-217,112- L_P 1 r�
CDS
SITE ADDRESS '' II SUITE/UNIT II
3C)(o0Z- PCV-,11411 c_ t�L~)L C Z
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# � � � - � f
°IOb Z
34
TYPE OF PERMIT CIBUILDING EDPLUMBING ❑ MECHANICAL
❑ DEMOLITION 0 ENGINEERING X FIRE PREVENTION
NAME OF PROJECT p
(Tenant Name/Homeowner Last Name) V �l 1 Li-,0,J a-� n �,'.a- )v1
PROJECT DESCRIPTION I1 0., j+t e e9 alp - -fy2 atayr\
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME 1911 (Jo{ ✓2_ F-I eL4 rl[ .L►'1�, PHONE- co - 3 r_ tn.\00
MAILING ADDRESS E-MAIL
CONTRACTOR 03 1 cA4o,LA.-s {¢,re14.0 c k a antoy e 2tD zn
CITY STATE ZIP FAX
eA44 e- ( `fit \Z c.0 Ili so
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE H
AL -LcY�W 6°1 C01 L - 7 / lL iW
NAME p PHONE
S te- -N;0-VN. TJ�QCJhS4-.Q,t'.^, iota q 3 CQ too
APPLICANT MAILING ADDRESS E-MAIL
30-t24 LSAA-ay"Lt 4Oi-,lik. S±. 9t,-eaw cQiLec r+( . Coves
TY STATE
FAX
CI
ek ZILi 25 V2.,(_0 z t -1:s- 41 2- 0
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
J ei2Ew. 7,0 6, 9 (o(agO . 1411w,ve S @ i„kol,coo,PROJECT FINANCING NAME iiOWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27095) 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 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 its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application. ,/'L
SIGNATURE: DATE -7/t l0
PRINT NAME: 3-ER-E-h- C_Ar l
Bulletin#100-January 1,2011 Page 1 of 3 k:vNandouts\Permit Application
S
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 IcommerrSal(
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 sins( TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utibty) WATER HEATERS(Elecusr)
HOSE BIBBS SUMPS WASHING MACHINES
,.,���"' 3 ., 'yds,�����•�� v�'�.� -... -. p.. - � 3 '°,�,* .,¢,., �`�. � ,.. ... .fi..� � "'�'.�`s� �ig� ?��� �t�,. �*_ ,
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?
J Yes n No J Yes J No
r o +w
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
•
4t.. .; - AAI .. k. ......._..
COVERED ENTRY
k,rE1' k '.�$ 1 x4iirelS6
GARAGE O CARPORT J
>n _
EXISTING PROPOSED TOTAL
Area Totals
-**1VEIW F1031 .±3U t � F .'
ESTIMATED SELLING PRICE$ # OF BEDROOMS
. x* "' _. s' "& • x-.�w ,
a e
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
,a 4''. ts ?s. x. sF'' rs> r.� •ea "" -,r, t:�k
�$ k °Y '+.'_#fi " v 4 . .4; 04,4 .. ;tea�, ... w .• f t« , r .t
4140
�
ADDITION
,, L ,.,. " ,a„ •'a
ijt
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square FeetType Stories
f€f7AL 1E3t Y1!T x, � .<. < ? < `� r'4� ". _ Yv t: �t .` •4
•TENANT AREA ONLY
•
PR�11�� a s
Bulletin#100-January 1,2011 Page 2 of 3 k:AHandouts\Permit Application