15-104843 1
41/4. •
CITY OF PERMIT IIPPLICATION
Federal Way RECEIVED
lSEP 23 2015
PERMIT NUMBER • ` 0 4 8 .4i5_
— _ _ TARGET DATE CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
b3 8ao R tt>41/4)Sc -- �c� A \,V
PROJECT VALUATION ZONING ASSESSOR'S TAXS � �/PARCEL# � � - Q j
23c Z OO /_fBr
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING a-FIRE PREVENTION
NAME OF PROJECT PCOM ev'C9_.. -eot PL41 Slew!�E
V\51- it yfe \ 1-0 (Oct9 -f-r-,r ,(Ne
PROJECT DESCRIPTION r
Detailed description of work to p 41
Detailed \c -C1 J'-�
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME (i RVN (_"t'r IC IN L. PHONE
i - 25 1-12 klOS
MAILING ADDRESS E-MAIL
CONTRACTOR g'Z S Wok \,•c r, °^ S . - \ SQvc) r l.- ''o I Sot kte G rr'c.i eL-
CITY STATE ZIP FAX
V\ v lA eVa5)1"-1_
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
()(50-4EI '?)l RC- 62-i /2,0/0
NO! PRIMARY PHONE
yrILOkra51�c 1��.� 5`3) 4' -1.3 61
APPLICANT MAILING ESS `AE-MAIL
W
C%i I {Zi'� �' .es(T 1 1)(-- E- VISC^1'l'Q.��L'4'�141�!
CIT STATE ZIP e o'� i. FAX
AME W'fy!* Olp PRIMARY PHONE
PROJECT CONTACT Q'([�1 \4[N- 6 H L tiuu�- i43) jj f'? QA
(The individual to receive and _MAILIN ADDRI.ss E-MAIL
respond to all correspondence 32-5 \n1 C;C\A ✓ t 5 '`'l I 1,- C /*vet
concerning this application) CITY STATE ZIP FAX
V a. Wi cv4303-
NAME OWNER-FINANCED
PROJECT FINANCING
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 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 city as a part of this application. `
SIGNATURE: .,M-__.._..... DATE vG 1 f 3 /7,0 is-
PRINT NAME: • 1,‘4-A.131
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
ir
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(conimerc al)
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 r
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS • I+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
$Z�v0
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes EI No
❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home
/!y!{ -
A./.1
:c.r ., c>., .,.,., ;'... �,,�:��f.,�,�rf,r.✓- ,r�,;�. ,::�;9�,li!/, i;,�� � ,/,.°,n/��,..J�.,
COVERED ENTRY
DECK /
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
r /
47-'7//'/,
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Type
in Square Feet Stories
/' F :277:
rl//"/"/ / %�!rF�rr „/
TENANT AREA ONLY
PRrtcT t1N�Y
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application