17-102411 RECEIVES APPLICATION
CITY OF
MAY 19 20178thPERMIT
PERMIT CENTER. +33325 Avenue South+ Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER _ _ \�
_ / I TARGET DATE
SITE ADDRESS ` l SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING fra.FIRE PREVENTION
NAME OF PROJECT l-ll)Q 5
PROJECT DESCRIPTION 4 c/ // / -1
Detailed description of work to / //�O f�'!/S rp l�S�//1/g el is-,
be included on this permit only
NAME - / PRIMARY PHONE
r.J al-).W-eV‘
PROPERTY OWNER
MAILING ADDRESS 4k gyp// E-MAIL
((eD CITY STATE ZIP
AME
N �� /�� /�lLU , ����� PHONE
MAILING ADDRESS �Y/ E-MAIL
ONTRACTOR /,/ds �o�r/e `r )occi
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME 4 PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
3 /1 / /.sayeve J
CITY �r�Z (//�/) 3TAT� ZIP 9 J 3 FAX
NAME _ GSC// PRIMARY PHONE
PROJECT CONTACT /;/`
(The individual to receive and y.MAILING ADDRESS % ,/ E-MAIL
respond to all correspondence 35/:// z c'-i1 SU/P i�
concerning this application) CITY STATE ZIP FAX
941- ,eSPOO
NAME
PROJECT FINANCING v eEr OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW19.27095) 6 2c1-/57//
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
PRINT NAME: /�
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Applic
VALUE OF MECHANICAL WORK
MECHANICAL 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.
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 fifixtures to rmain
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 ❑
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EXISTING PROPOSED TOTAL
Area Totals
orzimizta r 7! , f'r Aifv ,,
ESTIMATED SELLING PRICE$ I#OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area m Occupancy Group(s)
Construction #of Additional Information
Square Feet Type Stories
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ADDITION I I
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
S.uare Feet
pe Stories
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TENANT AREA ONLY
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L_Bulletin#1°°—january 29,2016 Page 2 of 2 k:\Handouts\Permit Application •