13-104753 ,
RECEIVED
CITY OF • 2 5 2013 PERMI' APPLICATION
Federal Way
CITY OF FEDERAL WAY
CDS
•
PERMIT NUMBER /5_. _ 7 1 (7 7-5 3 _ FP TARGET DATE
SITE ADDRESS SUITE/UNIT#
q7o?O PAc,r lc. law` -
PROJECT VtALUATION ZONING ASSESSOR'S TAX/PARCEL#
4111.44414-5/COC) - - - - —
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION
4 NAME OF PROJECT 01 f tt,l.y
1
PROJECT DESCRIPTION
Detailed description of work to t N,S-en I,I,p f 1 O N O U NnRG RO UNC IRE LINE,
be included on this permit only
NAME 0 ) PRIMARY PHONE
PROPERTY OWNER IECtill at/J-)
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
CORD'SON . CoN-fRAC'r0P6 360
0QCJ• G. • R314.
MAILING ADDRESS E-MAIL
CONTRACTOR P d' i0
CITY STATE ZIP FAX
SuoLbr1I3 Loh, 96,..0q2) 3E0. AAA- abAti.
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
/ /
NAME PRIMARY PHONE
-DA(r/4 I'IEADR ILK 1575'1. ,60i8
APPLICANT MAILING ADDRESS EMAIL
P d• &II ei0 DA v6 e GuRyo►.ki..1.4.C,o1,{
CITY STATE ZIP FAX
614.6H01i ISM , why 6/6496
NAME J/n^� � )LRPRIMARY PHONE
PROJECT CONTACT Ft vG f' ORIC.K 441.6 •19/- 5C9‘18
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence IA U- nft( On i• P GORSich16 kV..Gtr
concerning this application) CITY STATEPi
ZIPFAX
Spot-tot-1131- �60 i6
NAME
PROJECT FINANCING 0 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 pp1lart of this application.
SIGNATURE: Or''C /4/19 A /LDATE 10'O5 .06/3
PRINT NAME:_ OA U, QR iGk,
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
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
s
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
�+s 'r id11; _� i tea: _ �„ r
lgtlingnglf
' n. '` '-b.`_ _... 9�"I'gi�", � e4. � ,.,��`' .,..,r.�I,y/, .,z'�Y.-,.�a�'�"� .;%�';z��„�m g._S✓,sto
GARAGE 0 CARPORT ❑
OTHER(d s e 4'�/�i`r i e i oItioffintah
x
EXISTING PROPOSED - TOTAL '
Area TotalsYIPNNSNVPNIPIOSWftlittrWOO stm
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION '
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
NaIwBIIIL IN
� x
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
TO' I'UILI ING �/y �x \ 3 ti X
TENANT AREA ONLY
CT AIS ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\l-Iandouts\Permit Application