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11-104947 , 4 • LO± CITY OF ERMIT Federal W MF CO ME PL DE E FP COMMUNITY DEVELOPMENT 253-835-2607•FAX 253-835-2609 PLICATION www.citgoffede ralwaq.com SITE ADDRESS ITY OF FEDERAL WP ' SUITE/UNIT# 336r �y F5�..� WAN/ s , FI -D►z .r4L 1,,,Ay ,,,4. PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# /,s`c , �= . ( 1 o L - 9 n c� 2 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING )(FIRE PREVENTION NAME OF PROJECT (Tenant Name/Homeowner Last Name) ,�/i ENii.l 7 Z.-/-I Alz�(Si�..tZ PROJECT DESCRIPTION 1 N s T w i>✓A i►e,/� a 1` nJ n/c=1 'A 100.) 1 /V Tag_ rzl..E_vea 1 o 2 Detailed description of work to VNi 1q( ht IN/__ Teo O YY1$ 4 be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER VUE. j�2A4 usi-Z2 Ai 1A MAILIING ADDRESS E-MAIL 3360603 it�/�/ eni4A-E.� IAJAY 6 - CITY STATE ZIP f�/ZJ)Iz 12AL t -'A / lc/A- GJt ?OC 3 NAME PHONE FiI F ©nJ�z.-, //Lie. 7-06,- 7.-0 3-I MAILING ADDRESS E-MAIL -- CONTRACTOR CONTRACTOR /0-2 !i AS/l/A/et7-0n) gLv/�. Ne LS )"Ii /i.a/J/i.GRL) CITY STATE 'WA Z��'Op1 2;3-735--9'37& WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# f,2k_pi-i O9.9kit' S- / /& / /2 2n-Q -j(Z?9-C)C--13L NAME /' PHONE — v A1.5 2�bbl n�S C_1=1 iZ)i eik1/z/ l,JG� 2e4 S7 5 a 31 / APPLICANT MAILING ADDRESS E-MAIL /G7 /,vAchl/AJ€.ro ,ggL),), 1ivA(JQ/iA2.a"--en)E,ai2� CITY STATE yvA ZIP FAX 2 3-`73S--Y47( PROJECT CONTACT NAME PHONE C-�/R,� iabiA)S Zc -5-75-o3// (The individual to receive and respond to all correspondence MAILING ADDRESSE-MAILE MAH /� _ concerning this application) / r?LvA ' -1/nJ( /a�'`/ 131-JDt /_V,�r.)C /-,/Z/z`��'�� - CITY STATE ZIP FAX tIL.-iJ,4 WA algCd 1 263 736--9 VG ALTERNATE CONTACT NAME: PHONE E-MAIL A-)E-t-S & 1Ief Zoe,- c7S-o3i1 AVn.IC,07 i -cwii,alu_ PROJECT FINANCING NAME OWNER-FINANCED Required value of$5,000 or more (RCW 19.27.095) MAILING ADD S,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. 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: .re;)------- DATE / Z_IL/-I PRINT NAME: /Z4 be,-r /e44 Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application • • ,„4,,,,,t, _ , MECHAJICAL' VALUE OF MECIIAIVICAL WORK $ (a copy of bid or estimate must be provided) Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing factures 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 S1eIS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES ' RE' FI ,i•A' . : ' „, FIXTUS •.,.. Indicate how many of each type of facture 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 INFORATIO CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWERPURVEYOR VALUE OF EXISTING IMPROVEMENTS $ EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? Oi l iGi7.. 31c-)L 3 7 Z(,) 71 Yes ❑ No ❑Yes ')Q No a*• Na a aY ,,r.'. e RESIDENTIAL - .�Ew OR ADDITION i il'4 AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR(or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER(describe) EXISTING PROPOSED TOTAL Area Totals **NEW HOMES OTVLY** ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL—NEW/ DITIN AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information in Square Feet Type Stories NEW BUILDING ADDITION COMMERCI L''-REMODEL/TENANT IMPRO TMENTS ,;64, AREA DESCRIPTION AreaConstructionGroup(s) Construction #of Additional Information in Square Feet Type Stories TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100—January I,2011 Page 2 of 3 k:AHandouts\Permit Application