17-102823 RECEIVED
'‘, JUN 13 2017 PERMIT APPLICATION
(ITV Of'
Federal Way CITY OF FEDERAL WAY PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
COMMUNITY DEVELOPMENT 253-835-2607+FAX 253-835-2609 +permitcentei$/,citvoffederalway.com
PERMIT NUMBER ' 1 _ 1 ° g 7 / _ { p TARGET DATE / i{ '
SITE ADDRESS SUITE/UNIT#
3 8 2 0 w eileAr ha e u&ems Gocitl S
PROJECT VALUATIONo / ZONING ASSESSOR'S TAX/PARCEL# q Cr 6 _ 0 0
Z' S
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING [ IRE PREVENTION
NAME OF PROJECT Aloe 1'-1 y✓esse 14tVih Q1•/ Ce.-4-e.
PROJECT DESCRIPTION Odd Ixe.k AU rr 014✓t c eT �ij r , P-1
Detailed description of work to enco‘7 COI'Pi( y,O 0"
be included on this permit only
NAMEPRIMARY PHONE
Nw I< idne i GTg-
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAMEPHONE
A?eA £ )pLf(-pn Cc f,,75)1. /6 -9( f-‘ 1
MAILING ADDRESS
}� �j Seevir4 E-MAIL •
e4."CONTRACTOR ?c D•(3)k I 5 3 c harold(S y..4 tQs 4�
CITY ^P Q trI s S T4 Z �' FAX
Or
WA STATE CONTRACTOR'S IC' S-# PIRATION DATE FEDERAL WAY BUSINESS LICENSE#
L
NS fi o . . 6 / az. / ,, Zo-16-�o 6 0-78-0o-aL
NAME PRIMARY PHONE
5 04
APPLICANT MAILING ADDRESS /,' S 3 E-MAIL
PO e OX
CITY STATE o ( <, OA
ZIP q � O / FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS EMAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
Where value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
IRC:W 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 arise ou of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ci art of this application.
SIGNATURE: /4 DATE 6/(3/ i -7
PRINT NAME: )4 frV l d `T'��Vt,C
13ullelin#100—January 29,2016 fj Page 1 of 2 lc:AHandouts\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(commere)al
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(o,Tob/Shower Combo) LAVS(Hand Stinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility WATER HEATERS(Eleotde(
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?
at Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT i
FIRST FLOOR(or Mobile Home)
SECOND FLOOR1 ?, ,
COVERED ENTRY
DECK .. 4` ,y y
yqI
GARAGE 0 CARPORT 0
OTHER(describe) ® .1, m(
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY** ,:trilit.5,wtit'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Construction #of
Square Feet Occupancy Group(s) a Stories Additional Information
NEW BUILDING —'1,,,00,.+a �?* (' It .1 3
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Construction #of
Square Feet Occupancy Group(s) Ty.e Stories Additional Information
TOTAL BUILDING I � f
i E' lr f . ; ao°> z
TENANT AREA ONLY
PROJECT AREA ONLY 0 D G Agit!6 I..0'
Bulletin 4100—January 29,2016 Page 2 of 2 k:AHandouts\Permit Application