17-102890 i` •Nii
RECEIVED
1TY O€ ,. PERMIT APPLICATION
,fir Fedal ilVay JUN 15 2017 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(acityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
0
PERMIT NUMBER 11 _ l 2- g70 - . p Pr'
TARGET DATE N I
SITE ADDRESS SUITE/UNIT#
31515 Ptfe- v n fr LA bowl e - W S 112 # (19**
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ % -01) `L 0 7 7— l O V _ 1 3 O 2-
TYPE OF PERMIT ❑BUI..DING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING ? t'IRE PREVENTION
NAME OF PROJECT j0k4 Mfrl MOY19011 AA 60'111
PROJECT DESCRIPTION Afn`9' ,UAc. Paver ?nine( [Oy c o-kr Polo
Detailed description of work to COAs eitte -Cfre- leucce5 AMC- Pc> eI
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
rye
NAME A6 PHONE
r/ 6 t (-877_90.1
87_Cyv -6110
MAILING ADDRESS E-MAIL
14.ob - -7/111 4,f Li Sutfe 'OO PhoteL.tvn %t'r,I.iI. Cot
CONTRACTOR (_ { Mote
�/ f j y�y�
Uri - l y 1 lite STt, ZIP 9 8 bu FAX
( I r,'
1l'cP — �3
WA STATE CONTRACTOR'S LICENSE# FF EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
)M H0U Nf i O Q• / ?,o-n- ralsso•-foo- BL
... _ .._ _. PRIMARY PHONE
NAME An^L, 60 ,43-'sl,6-333-1
E-MAIL
APPLICANT MAILING ADDRESS r coat N_
w �ro ferx�►� �1ti,afro
740 6 1�� yf �i
CUlt‘ STATE ZIP FAX
fo4Ar le 46
NAME/� PRIMARY PHONE
PROJECT CONTACT AO (CY v;3-. )$+6- 33)7
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING ❑ 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 to the city as a part of this application. /�(— /
SIGNATURE: DATE 6/ f 5/11
PRINT NAME: An 4' 16i
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 of fixture to be installed or relocated as part of thisproject.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/utdiy) WATER HEATERS(Eleetr(e)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
.1Db
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING F�IRJSPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
G)C I,1*. Ftw pc el CI,044
F7
Yes n No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
44R(4i441
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Te Stories
E r E e
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet
T AL 144*DING
e Stories
TENANT AREA ONLY
OJEC F
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application