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16-101956 • CITY OFill& PERM T APPLICATION Federal Way RECEIVED PERMIT NUMBER t. (to _ (0 A P\R 2120516, _ tIQTARGET DATE �nERAL WAY iiliCr SITE ADDRESS CDS SUITE/UNIT# 33010 wt✓Yt�2 oil gusa2 tW4Y 5. Z'"d r2 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# Z I s 9 G Co - 6 0 3 0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING XFIRE PREVENTION NAME OF PROJECT MN S ..t\ _ TALOO 60 004,-a C_. PROJECT DESCRIPTION Aov RE Loc R i L f l aF SPlz!kw—a 1-; ,,ROS Full-- Detailed description of work to lVL J IA1AI.LS . be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER M,VL rvl lt)e1NL N l)►N C . MAILING ADDRESS E-MAIL 4,-us- UL' 4.i1 N� 50.1-e. SDC CITY STATE ZIP Kt214.t. ( 5g0;3 NAME PHONE P6Ce\/YT Ft2E PQO Ii ttTIO .>J I,uL ZS3-124,--22So MAILING ADDRESS E-MAIL CONTRACTOR 2-70 7 _7U' AVL. &- CITY STATE ZIP FAX /ACo w►- cjd^zy ZS3-`/22--6/TU WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# PA1-It1 r'fr q CI= / NAME PRIMARY PHONE d\A AC-Ccs- Z53-124-Z2-e70 APPLICANT MAILING ADDRESS E-MAIL` 1 CITY G S 6-.4r4...L�. 1^.no(C P....iy e4c:re.. C STATE ZIP FAX 1 NAME PRIMARY PHONE PROJECT CONTACT <S Ay I i'c c...'"N- MAILING ADDRESS E-MAIL (The individual to receive and respond to all correspondence concerning this application) CITY STATE ZIP FAX NAME PROJECT FINANCING it//A- 0 OWNER-FINANCED Required value of$5,000 Or more MAILING ADDRESS,CITY,STATE,ZIP j, (RCW 19.27.095) pHONE N/k 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: .-----7.---.----_ DATE Li/2_1 i PRINT NAME: id 1't.,..- 0,...-( c Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application • • MECHANICAL PERMIT �VALUE OF MECHANICAL WORK 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 PLUMBING PERMIT ��VALUE OF PLUMBING WORK 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 KYes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR(or Mobile Home) SECOND FLOOR COVERED ENTRY ; " DECK ��d� _._....._..................................._.._....................................._...._._. GARAGE ❑ CARPORT ❑ OTHER(describe) Area Totals EXISTING PROPOSED TOTAL **NEW HOMES ONLY** ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL-NEW/ADDITION AREA DESCRIPTION Area Construction #of in Square Feet Occupancy Groups) Type Stories Additional Information NEW BUILDING ./4/ J„ ADDITION COMMERCIAL-REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Construction #of in Square Feet Occupancy Group(s) Type Stories Additional Information TOTAL BUILDING e2 oma© 605A/255 Cee 6 .ISI;- A Z F,117 cfr.'ay...vered TENANT AREA ONLY h` 6S-I PROJECT AREA ONLY Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application