14-103857 CITY OF PERMIT 4APPLICATION
Federal Way
RI
CE
PERMIT NUMBER I
- I `' 0757_ J UIVL'�L 31 2014
_ _ TARGET DATE
CITY OF FEDERAL WAY
SITE ADDRESS SUITLhtiI1WI�T#
; aa / / /l-C4 ` , I..VU J,
., , ,
PROJECT VALUATION ZONING SSESSOR'S TAX/PARCEL#
.2_ o 2 / a 7 6 5-1
TYPE OF PERMIT .
❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT ,_ l',�/ /40,711S5%b� .ce-c/1-,77-eCe__
PROJECT DESCRIPTION
Detailed description of work to (7 r( Z-14/-e-- — 4(7v. x, ere u","'
be included on this permit only
NAMEPRIMARY PHONE
PROPERTY OWNER j� -- �-�/?J .CSP6 tJ-ei . jy grt,c 7-ve-e.
MAILING DRESS E-MAIL
CITY
1 G ef'e�r ge /44420'� ZIP
�7S 0'x 3
.
NAME get,Irir l '// 1N5'//14#/ !V'/Y� PHONE 472 -gl.2-1
MAILING ADD S •, E-MAILr
CONTRACTOR 4 D Z 3 /3 f4 i,�`{/V44,e- CT E ! �e A.freizy GGT. ‘,,,s4
CITY STATE ZIP FAX
5/441"4,114641-yG,4 78387
WA STATE CONT CTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT /�� J�%�Gu 3 — S''g7I3
(The individual to receive and MAILING ADDRESS n�," E-MAIL _
respond to all correspondence oZ�o d 2 3 /3 /7VC/Vtt� GT /GLS�' �'r f CGl
concerning this application) CITY STATE ZIP FAX
,5,.,-,,,,-„,„7 WI
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 apart of this application.
SIGNATURE: rliV�1' DATE 7 r 3/ ?V
PRINT NAME:
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(Goo)
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/ut,vty) 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 ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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COVERED ENTRY
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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
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COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application