13-105268 4. • PERMI SAPPL CATION
.-IH OP
Federal Way KECEIVED
� NOV 25 2013
PERMIT NUMBER l �/ _ 10 2 l�/g _
_ TARGET DATE CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
//l * ' � /�1� 1 s0 • AZ. � / 4049 eon
PROJECT VALUATI N ZONING ASSESSOR'S TTAX/PARCEL C# ® � 0 _ � � � O
..3// 2,0040-1::$..3// 2,0040-1::$ - - - -
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING IRE PREVENTION
NAME OF PROJECTAzia, r-tAi-
dio
7-2) az. 8.il 4°-1°
PROJECT DESCRIPTION . .w.4 .
Detailed description of work to V
be included on this permit only V INC I;Is IP'
V
MARY HONE
PROPERTY OWNER
NAME ul/t/Cl&—S . 7 -e-miv APV-
yj 4�`'3 or)
MAIS •idof ., lie4re MAIL
'CO
` •
�:& S�pA1'l#ZIP 9q
NAME, // V'YW i/ .III/ /f�c.�
L zpe P� �'` -J .1113R.4
MAILING ADDRESS/` E-MAIL// •
CONTRACTOR / '(946 a0 �,V C:22-00 A40,4 n s �
WA ZIP 9<f CFAX 04) 7,p�� �,
WA STATE CO TO ~C/ E4 EXPIRATION DATE FEDERAL WA BUSINESS_LICENSE#
71:7,"71)^ O( � 44/V400?/0/ IC
644
NAME /
", _717X./.9;1 ,d-- • PRIMARY PHONE
APPLICANT MAILING DR
C��ve/��- fr
.cam . E-MAIL
CITY STATE ZIP ce, FAX
PROJECT CONTACT NAME�G, ,,/ ./9 /72, 9 1 % ����
(The individual to receive and MAILING )DRESS E- L
respond to all correspondence
( �\\�,y®/ �D 9cicn...v
concerning this application) CI'T'Y/��...465 `�1 STATE ZIP FAX
NAME4/(//')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 ant 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), ich may be made by arty person,including the undersigned,and filed against the city,
but only where such claim a es out of t reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the p• o his application.
40
*bid . Q --14.-3
•
SIGNATU' ,: / _/Q� DATE
PRINT NAME: -/LO V/✓ "IJ, V ' "_O _ )
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• VALUE OF MECHANICAL WOR
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
*> s `q r ". l VALUE OF ItuNIBINQ WW.`�.
PLUMBING PERMIT $ `
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include_extstingJixtures-to remain.
BATHTUBS(or Tub/shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWAiHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
•
DRAINS SHOWERS VACUUM BREAKERS
IV( IG O T)`lT NS SINKS c
(bkuhea
JG ",•Ayf1TER.HEA'i"ERS(E1eMric)
HOSE BIBBS ' SUMPS WASHING'MACHINES TOTAL FIXTURES
•
GENERAL
INFtQRMATI,ON
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR 3 SEW$$ 1, r VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
` , , r Yes a. No Yes ❑ No
•RESIDENTIAL — NEW OR ADDITION ,
AREA DESCRIPTION(in square feet).* EXISTING PROPOSED TOTAL ' FOR OFFICE USE
,r•'%E�RST +�'fsD"OAR firir b'ite�le�ia.� ' .
of --
.0 ,�;e€,, _„, „,,.... _, i�,.x.,,,figs„, ,, r✓,s-fz� x„. ..,3 ':a,..: E .„"...a- _ . _
t C@V RED ENTRY . • •
• �E zr � r
GARAGE 0 CARPORT 0
OTHER(desEnbet
E USTINO 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 FeetType Stories
s
• r
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType Stories
ur
TENANT AREA ONLY
•PRb acT AREA ONLY •
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application