15-103350 ,..
Y CITofA. ,..,,,tt,s. IFE,,,ED
PERMITIKPPLICATION
Federal Way JUL 1 0 2015
CITY of FEDERAL WAY
PERMIT NUMBER / 5'
_ 0j..C2 5_0 _ —
p TARGET DATE �)
SITE ADDRESS SUITE/UNIT#
2 74o4 ?Ac/F<c !-fwy S. 14/A
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 53, 5-00, co gG 3 a ¢ a z o - 00 8 1
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ligr FIRE PREVENTION
NAME OF PROJECT F-6.VERA L LA/A'/ V E-rEv-A6-1 5 664-1 7-67.1Z
PROJECT DESCRIPTION —06516,,.1 S. 1451-A u- WA1ER 13P 5cD Av'ro,A-i1 c- Fig
Detailed description of work to 51'g'AK(-CR- 5 yl-re-A.A. Ti-112 ou ti N ou-r BV 1 p 1,...1 GI .
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER M!�G FEV EVAL 'dA y V ETERAAt S, L.c 25"3 8 3C- 7107
MAILING ADDRESS E-MAIL
MOO S. 3367.1.1 goal.)c. c Mui--11
CITY STATE ZIP
FED C.- Al. 'v/A A ciSbo St✓(ZvIcEct,n-ez.Go,...t
NAME PHONE
'REl-IAr1 cE FIRE *PR 01-.C4-1*a04, 1.JC. 204 6SZ- 6636.
MAILING ADDRESS E-MAIL
CONTRACTOR Pa 13oK 4 2 s
CITY STATE ZIP FAX
?'R-e STed WA `t 805-0 2 ot. 4432 -674#
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
R.euAFP 102 LI 12 / 31 / 15" Zo-o 3- 104541 -0o-in
NAME PRIMARY PHONE
SAME A 5 404- jtALTo1Z
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT KEJ/,J ie,JSEr,1 204 !082- 443(0
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence p C Soo x 4 Z$ KEv1,1 G I-1,q„1t.E f11LE.coM.
concerning this application) CITY STATE ZIP FAX
'PfzESTo,J WA 98o5-0 2c4 6Sz-10144
NAME
PROJECT FINANCING N/A 0 OWNER-FINANCED
Required value of$5,000 or more MAILING AD9RESS,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 its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application. �J
SIGNATURE: �� 1111\‘./.1-".."
ilik DATE 7////5
PRINT NAME: t41/;n Jul St/
Bulletin#100-January 1,2013 Page 1 of 3 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
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 INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
LAKE1NAv61J
tI 14 o W/.l t 1 i1y D!Sig/Cr $ 5 467, l/(.d8
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
�, SS a ❑ Yes ❑ No XYes ❑ No
'R ETA)L 5?oi E
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BA EME+NT * W �/ yy�/rIA 14, mama o
/
FIRST FLOOR(or Mobile Home)
. O Ia r _ i''/ i� �''fir/7 ,x,Asn�� - .. ..,.. m
fav " /j ars 86 1 1 //r%'�°' TY�i
COVERED ENTRY
1 'Qi1 /° O Ne r
tin limitient,
D
r •• 1 iy r� oras
GARAGE ❑ CARPORT ❑
IiiOTI3ERst fie} /' s % r'A 7?s� /r H /%
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
// °`a.<;% of ` t e fMit$1 / /y/01 s' 1trr t- / 1M rri a a „i
�'. c'•a E a r�/i X 00/ .a ,���f / `� i.'24M /� . Y h..,. /i„r ;� io p ^fir
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
ar ✓i/i/4/i/y "�'�/ a// / t o MAW y army 1 1 1 y//�
'1' TAL S LI1I //
cgit
Ainato r, .�,>,,, _... �� r/ /i a , .,,t;,
TENANT AREA ONLY
P - '%/ ` i `,!6 p r frT a/iyr
smf .s!A'.�� rl E 3 S // *Vaasa ` ,
Aar
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application