09-103360 • - • A _ / o ,3_34
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cm,OF ..0 PERMIT SF' MF CO ME EL PL DE EN FP
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C - -1607•F253-835-2609SERVICES APPLICATION
www.ciluoffederalwau.com
•S Det8li°6 o ti„taii
yDaubjecticltPROPERTY ;
,
SITE ADDRESS
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t8 ?IITE/UNIT# -....-....---
ZONING ,.a ASSE�SOR'S TAX/PARCEL# Cj �`I0/� ��
-- ✓ _ 'r'� V ref:
NAME OF PROJECT ,
Tom- -C.,--1%---k 9
•,-N,
(Tenant or Homeowner Name) i CL 0 ,1..) -.” C' " IC 1
❑ BUILDING El PLUMBING ❑ MECHANICAL t"
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING AFIRE PREVENTION
R..e,p 1 p C, C l'.. H( Supp -re.s5 1 o In 5As~ceXn.
PROJECT DESCRIPTION i-o a J Q Y fl i U �Ci �12
Detailed description of work to p
be included on this permit only
r6 ,✓. a ,6//i y6/ �� - X33
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: CONTRACTOR ❑ APPLICANT ❑ PROJECT CONTACT
NAME PRIMARY PHONE
Q.*T t-tood, ox Duct (-30(o)+ - b9it li
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
UtOC 1 - C,_,0e . S - 5( ,u) ( )(i,) o - auG1-
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
i t-t06JDA-66E W L 1a , ( cei `f '-JO5 !
NAME0/12)t)21'1 C���,, i PRIMARY PHONE
APPLICANT FT I t't / \,_� � 5 X I r e b k-- (- k1) e)( - 0921-C
MAILING ADDRESS,CITY,STATE,ZIP FAX
i C;L i -'4 I-1i (:/.._,,-- .. C)• Seata . i,-ri ( ) 'l-- -.D(pG—i
PROJECT CONTACT NAME ��e ,
Y_.4' _.)t-e_.)t-e...0 � ►-,
PRIMARY PHONE
(The individual to receive and .
I l _S / ( of Xi 1Q,O11 ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( ) -
PROJECT FINANCING NAMEf ,
�' �✓ OWNER-FINANCED
Required for projects with --�
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27 095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tothecity as a part of
this application. L.,SIGNATURE: `�✓ JtC.C�C�1 DATE C7/O /OZGG�"J
PRINT NAME: /0"../S7-0-40 t/ tt..3
Bulletin#100—4/21/2009 Page 1 of 4 k:AHandouts\Permit Application
• •
MECHANICAL FIXTURES
Vah tP of Mechanical Work$ (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 OUTLElb OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercta)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
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(orThb/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
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ qaS. cc'
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
o Yes o No ❑Yes o No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL— NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/21/2009 Page 2 of 4 k:AHandoutsTen-nit Application