13-101320 CITY OF • PERMIT SPPLICATION
Federal Way RECEIVED 51;03
PERMIT NUMBER I ` v t ✓ 2O _ F MAR 2013
TARGET DATE
Crl Y OF FE�nUtvAL WAY
SITE ADDRESS SUITE/Hill?�CS
33 c21P f'ek-t_L Esc. s
PROJECT N ZONING ASSESSOR'S TAX/PARCEL# L ± _ 902 7-
TYPE OF PERMIT 0 BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING,.FIRE PREVENTION
NAME OF PROJECT V--64
6 '-- c9k) ( A)
PROJECT DESCRIPTION P L c-tcfs --uo G r S 7 6-- ( kj S�5,
Detailed description of work to
be included on this permit only
NAME6 PRIMARY PHONE
PROPERTY OWNER QQ d
MAILING ADDRESS E-MAIL
CITY STATE ZIP
MORE
MAILING ADDRESS E-MAIL Si
CONTRACTOR '/( l( 5; T6 )b ( D-
CI STATE ZIP FAX
AAvc ‘If _' W t' F C) 3z 57( �>�S
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
56' PLC) i , Eta- I isL
. NAME ^ - . . PRIMARY PHO
�Vr �
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
P
PROJECT CONTACT NAME OWL � �/ PRIMARY PHONE
Z531-6
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence q(( W c N t Q Chi-e t i-r evk t-esst '4GS
concerning this application) CITY STATE ZIP FAX
Avt)(.00. L2- (et-)1°\ 0 _ 300 r7 l- 5
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 such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where such claim ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied - .ty • •art of this application. 3kic (
SIGNATURE: . Pir
DATE 13
PRINT NAME: I0'Ir, 5e11--;660 --7
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)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(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
FIRST FLOOR(or Mobile Home)
f'1-144 .
COVERED ENTRY
._ .'�+`+�N, 014,:;. lg* "h..` iV ,"3,:i....#: 4*P .rc., ,n. i 4. :1; SSE ' -. --,...,
GARAGE ❑ CARPORT 0
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ I#OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Stories
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
AreaConstructionGroup(s) Construction #of Additional Information
in Square FeetStories
TENANT AREA ONLY
t
ms' s"" �" ",� ".. ': ..,-y u f,... 1 `_ _ . ,r r MM *AM-,10 .. a _
Bulletin#100—January 1,2013 Page 2 of 3 k_\Handouts\Permit Application