09-102812 ed�rat Way "° PERMIT S4F CO ME EL PL DE E gip
� � LICATION / /�'
COMMUNITY DEVELOPMENT SERVICES
253-835-2607•FAX 253-835-2609
www.dtuoffederalwau.cm I!
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SUITE/UNIT# ZONING t ASSESSORS TAX/PARCEL#
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NAME OF PROJECT
(Tenant or Homeowner Name) -7
0 BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING ."FIRE PREVENTION
it4ft74 6 -i ' SZiv;t '
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME ) PRIMARY` PHONE
PROPERTY OWNER '- f t7^' R-6707/t9 (�f i E " 3 - Sz /3
MAILIN,ADDRESS,CITY,STATE,?IPE-MAIL ri
ty "leel 61011,114409%4 1 itel-
OWNER IS ALSO: ❑ CONTRACTOR i7 APPLICANT ❑ PROJECT CONTACT
NAME , PRIMARY PHONE
tY�it l'I t -tel f CLtl 1 ` -f C
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
C t )C:')+ Z 1.
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
APPLICANT
MAILING ADDRESS,CITY,STATE,ZIP FAX
PROJECT CONTACT NAME PRIMARY PHONE
r � / q
(The individual to receive and (do(e 5(0- l 0 p
al
respond to all correspondence MAILING ADORES CITY,STATE,ZIP FAX
concerning this application) ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19 27.095)
)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a of this application.
� /27
SIGNATURE: �v(� DATE q
� /
PRINT NAME: l s i G{- 1 N1)/\
Bulletin#100—4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
MECHANICAL`FIXTURILi .
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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
PLUMBING FIXTURES , ,1
Indicate number 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
PROJECT VALUATION
'$ OR SEWER PURVEYOR $
ER PURVEYGENERAL' INFORMATION VALUE OF EXISTING IMPROVEMENTS
'3 .�� �
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑Yes ❑ No
RESIDENTIAL i;,;
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT —--
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY — — A— —
DECK
GARAGE 0 CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**%VEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION le`',,4._ . 7 -, i
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
NEW BUILDING
ADDITION
`_ COMMERCIAL-REMOD" 4
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application