17-102611 PERMIT APPLICATION
A,
CITY OF
Federal Way PERMIT CENTER+33325 8th Avenue South tir �hl 03-6325
253-835-2607+FAX 253-835-2609+permit '.com
PERMIT NUMBER 1 _ t v 2(p ( \ _ 1=9>
MAY 3 1 2017
- -
- TARGET DATE CITY OF FEDFRAL WAY
COMMUNITY DEVELOPMENT
SITE ADDRESS-e 34 W e h Wc}./yv SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TA/PARCEL#
$ ail• CV t ( 0 LL - q 0 3 l
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL/ L0 DEMOLITION 0 ENGINEERING X FIRE PREVENTION
NAME OF PROJECT V V6 Gj(0/i\\ C-�( /V)A O/ Al...,—)
PROJECT DESCRIPTION lW�
Detailed description of work to
be included on this permit only
- ---
NAME PRIMARY PHONE
ci _Doy-tcx VtSi ori IketxcAV cc ti a 2-�i 3-' 3 • I 1�`-i
PROPERTY OWNER MAH G D E-MAIL
3 6 kJ e h ..Z. Lv S.
CITY STATE ZP
ec� - (. ,, LOA "
c4Q(43
NAME K)£Yl Ue — 6.re �,,�I- JV L. �o� -9-a --3-So),
MAILING ADDRESS , E-MAIL r1
CONTRACTOR D. t.c 4E-MAIL3 Nre.- • S, j it tpk. D 140 rccf.iC+C)n LA i^e,
CITY STA1X ZIP LJ FAX t� tom j,vt r ,(7-61,v1k e4'- t c1.3 bta.� at, ' ?-.. -3,..-7-5C)44—
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
1,3o-12T-1i F�6q�('-u O 3/ i u / (T R D R Io • (v 14d-77 -co•: --
NAME PRIMARY PHONE
Kct,I4,u a`i tcvi-cZy cv e i-ki,u--c.11-6 vy (- ,p 9611--7a,-?-5 c'' -
APPLICANT MAILING ADDRESS E-MAIL
)--a tD 4S 83rzkAve_.S. BtcG�.D Kere..tra,nw“ire ;,�I .(iNc.
CITY STATE ZIP FAX
K ,t w� "� �3a )0i) ��aa
Nr 1�l _ PRIMARY PHONE
PROJECT CONTACT k tA.t � -.e.w LP.19-91 501--
(The
b'J--
MAILING ADDRESS E-MAIL
(The individual to receive and �{r) ,
respond to all correspondence )`�(24-S t�2 - S- 1(G�!%f 1'-0-4.14Dr1.tAD V`ecs Lpie.
concerning this application) my STAT ZIP FAX J LL
PROJECT FINANCING NAME t--) ik 0 OWNER-FINANCED '
When value is$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
�-/ttoo/the city as a part of this application. l�; ? �J e y
SIGNATURE GI l V(i tkLak_ I4n,,^ � /7 t A- ,Y 6..i t , %( .(,t5DATE i'1 . LC/ `I
PRINT NAME: \'1A-1-h 1 U T .A.V(2.-- FZYy - K 1 1 T x.) j( -E- \r r--6,41-{
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT O /P $
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
A.- VALUE OF PLUMBING WORK
PLUMBING PERMIT i�V $
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(Eectr.)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
ND C/7' t, k 0 P` 'q 3(,e7)$
yr/�
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIREE PRINKLER SYSTEM? PROPOSED F SUPPRESSION SYSTEM? ,/{A
At eY" 0)- 0t'PCYes ❑ No (.4„�)4 JYes ❑ No w- ,61.
ii I
RESIDENTIAL - NEW OR ADDITION f\
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT ,
FIRST FLOOR(or Mobile Home)
"'}' ,
SECOND FLOOR ',
COVERED ENTRY
a
DECK
GARAGE ❑ CARPORT ❑
OTHER{describe)
EXISTING PROPOSED TOTAL
Area Totals
'r ..my HOMES ONLY**
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Groups) Construction #of Additional Information
Square Feet Type Stories
=z.." NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area m Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDIIN(i c G1 04 D
TENANT AREA ONLY i / 0;044
•
PROJECT AREA ONLY61.3• itAki-loyetvtrovt,, 41
) G u'�`y,,i dK i
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application