16-102334 CITY OF = PERMIT PPLICATION
Federal Way mg 16 2,016
/j//.. OIfY OF FEDERAL WAY
PERMIT NUMBER / / /l _ / O cg 3
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!! t� TARGET DATE
SITE ADDRESS SUITE/UNIT#
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PROJECT� VALUATTIION ZONING ASSESSOR'S TAX/PARCEL#
$ \✓ . i \2 1 .00 6 0 d 0 _ D U T O
TYPE OF PERMIT ❑ BUILDING D PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT �\_,_ CD A'L1 �� l C__0-,(C'.
PROJECT DESCRIPTION /� � •
Detailed description of work to '-\ C( 2-`b Co,:ke, S Qc , v_..\exS ko`c \fJ(,\\,-2, ,,,,,C,
be included on this permit only
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NAME -
PRIMARY PHONE
PROPERTY OWNER \--\A(-6 C,` , \-\,,,(ec co cQXk•I GS LkX,,
MAILING ADDRESS E-MAIL
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CITY STATE ZIP
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NAME� • PHONE
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2,2.
MAILIW,ADDRES lE-MAIL
CONTRACTOR 5J� 1/� (�A-,0�'7k� JSS e.'.be(t�t&ch_(C osA c(u c.{.0,
CITY \ e__n} STATE ZIPTT O 3 - nFc�-( ^t- �/1 fl �j
W STATE CONTRACTOR'S LICENSE# Wr/�1 EXPIRATION DATE ,FLEDERAL WAY BUSINESS LICENSE/S #
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NAME C. PRIMARY`�J e /-A�\/ _e.C. L J PHIi --v(i-L
APPLICANT MAILING ADDRESS E-MAIL
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CITY STATE ZIP FAX
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NAME LA(
' n PRIMARY PHONE
PROJECT CONTACT LA \C�SC • /"\ CJA<Q c ri.. -Cj1`L-/-2VL
(The individual to receive and MAILING ADDRESS }� E-MAIL `_
respond to all correspondence --- SS S �0� S� S�e.',,7[,'C-t QAcc' .c cX(0,1w
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,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 •• of this application.
/ /i /� /
SIGNATURE: DATE CD --- l(2 - \b
PRINT NAME: C. \C.� C'. / u (e_.'�
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(Handsinlca) 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
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes Li No Yes Li No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
S
GARAGE (':1RPC)RT
OTHER(desseribe)
— v._ _...._......_............__............._..........................................,._....................................._......._...........................
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Groups) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area Construction # of I
AREA DESCRIPTIONOccupancy Groupls) Additional Information
in Square Feet T pe Stories
TOTAL BUILDING .rA«
TENANT A!<Il ONLY
PROJECT AREA ONLY r �^ %'".rl«"� rt
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application