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10-101663 c.,.,„} :: :::.::::::: lePERMITlie_ - __4 _0_ --/--&& Federal W p�1ME PL DE EN FP COMMUNITY DEVELOPMENT SERVICES APPLICATION --�/ 253-835-2607•FAX 253-835-2609 ,vu:c•ciu.ei-lid,,,,:r N.,:Cer! SITE ADDRESS i c NIT# 329\ ( 11v,� .S, fC0rK--11 L 0 Ay �pf� q 6 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# ( .{i j BUILDING 0 PLUMBING ❑ MEC TYPE OF PERMIT by � ' WA y XDEMOLITION 0 ENGINEERING D FIRE PREVEN ION NAME OF PROJECT - (Tenant Name/Homeowner Last Name) j� -_ PROJECT DESCRIPTION"�O t7 E ( FL.Vi c-E. t t{®o . c. - ,S(f)✓IU& Cj4-}A I- 5 Oki Detailed description of work to (OOP $ K f ) be included on this permit only NAME- ' PRIMARY PHONE PROPERTY--OWNER e- - LIN RE 1 Ct t � E-MAIL. 321 3 5 1 D AG V4 CITY STATE Z • SOC NAS 'I PHONE Com:" rd Cc 14 V /).*•.(P•F il(Aour4NQ CO3-6(V --f e)-3 MAILING ADDRESS P` / E-MAIL, — CONTRACTOR zq l� �L / V Koc_17l, 60"` • ,. `II CITY STATE ZIP rAx GK“1÷1- OA ?70a0 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# C.,1 GC( PV q tO 7 -7 / / Za-o°i-t oosg NAME PHONE APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX • PROJECT CONTACT NAME PHONE (The individual to receive and .- Z (-1 L respond to all correspondence MAILING ADDRESS , E-MAIL concerning this application) 1 11 01 u Wilk) A(1 CIT., STATE ZIPFAX t-NYt-iN ©rte cjq yL S 1//„ ALTERNATE CONTACT NAME:. PHONE E-MAIL 2k6-4eZ-b?4( PROJECT FINANCING NAME ,„„_.------- 0 OWNER-FINANCED Required value of$5,000 or more (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE 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- /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 • ade by any person, including the undersigned, and filed against the city, but only where such claim arises out • reliance of city, including its officers and employees, upon the accuracy of the information supplied to the ci ` : •`•a , his appli•Pi • � ii SIGNATURE: OfflrI DATE ti - A-7- \1 PRINT NAME: 5-TI f YG. A N vim= L P("s Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Permit Application • Kai VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided) 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 •�•'� iiiii}::::::;fir::,.:,:;:;:;}�Gi{G:y}}:::{:i:'{!}:•:•:"}i::':ii.: ::i::}j:{is�$�}iiiii:�ii'ilii$+::::}:{:::;:;:{:+}::TSy ::L:::::'.::isF::ilii}:�i::iiG:i+::ii'i:•,:i':;iiiiiii:::� L;:jIi�:Sj: ::i•}r.:rYq•:f.ish{::v:v::::v';iv^::r:•::r'•}:::!v"SL•::}:.....:. w:::::v}::v};}:•i+v.::::4:v:.w::ly::v:::::v.�::::::::v.};O}}}i:+:vii•}iso:4:4:•}i}:4:•}i}}}'.}'.}'.yi:.}:.};M.,i;• 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(Eeotuc) HOSE BIBBS SUMPS WASHING MACHINES 'i���'•�%�%%��`���. •�' '' ......, .•?.•ii• "%ki�iE<?aii5:':•`'.•�'::%''';'::'.i ::::::%` v' ii`i::. :'••:i;:::••:::::::••:::::••::sR:::i;:::?:::i::i::is:ii:••:::i;:::::••::t::i::ii::i:: ii is:i;;:••::