17-102774 RECEIVED
CITY OF '�...- PERMIT APPLICATION
Federir JUN 0 9 2017 PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
al Way 253-835-2697+ FAX 253-835-2609 +permitcentertcityoffederalway.corn
CITY OF FEDERAL WAY
COMMUNITY ��/EL�ENT
f
PERMIT NUMBER _ ( r c
o r f)
TARGET DATE
SITE ADDRESS
SUITE/UNIT#
P-ve, S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ RA `"
T O / 0 O
3 —TYPE OF PERMIT
0 BUILDING 0 PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT vu N.e1,J�nU a I jTe- -f- 11/41
PROJECT DESCRIPTION
T 2 vl �� 5 T `led n r- uvAt e o+f
Detailed description of work to l're-v a.\av VV\ r
be included on this permit only g `�
NAME PRIMARY PHONE
PROPERTY OWNER �ieck (AAeU Q,V
MAILING ADDRESS E-MAIL
CITY STATE
R & ZIP
NAME
PHONE
S9eA ��` e. 'ri%,(34664) L- 61c). g5(1 L-/* (11.1 L
1
MAILING ADDRESS MAIL
CONTRACTOR 311
9
su I s ROAD.Co t\A
CITY (19STATE ZIP i1` FAX
ICU
WA STATECONTRACTOR'S LICENSE# O CV/MC,
DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
saAj\tisL
APPLICANT" MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAMJ
PRIMARY PHONE
PROJECT CONTACT
�q )
` S 3 o
(The individual to receive and MAILING ADDRESS V
respond to all correspondence E_ -5 rn, U 'T I��0.Cone,
concerning this application) CITY STATE ZIP FAX
NAME ._.PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 • he c a part of this application.
(/!
SIGNATURE: - DATE �(J-67-17
PRINT NAME: Tom I 8j///((/
Bulletin#100-January 29,2016 Page 1 of 2 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 offixture 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 ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE ❑ CARPORT El
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in OccupancyGroup(s) Construction #of
Additional Information
AREA DESCRIPTION Square Feet Type Stories
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Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application