11-104077 11 - 10 / 0 /74-
Federal
10 / 0 /-4-
Federal a EJVLPERMIT •MF CO ME PL DE EN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION
253-835-2607•FAX 253-835- 0
6 r r i
w Mw_rir5of(ederafwau.co,,re!OCT' I 1.0.1
CITY OF FEDERAL KM
SITE ADDRESS SUITE/UNIT#
329o( c t-, rli®>?c./ 6-)A .p0",.. 2_0 54-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ / 15 . `'' 1 c 2l 01- - qo la
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING [i] MECHANICAL
❑ DEMOLITION ❑ ENGINEERING AFIRE PREVENTION
NAME OF PROJECTp ti
(Tenant Name/Homeowner Last Name) w"'S d1.t,:;<.r kit-C_ "'-
A)
PROJECT DESCRIPTION r1 "' v Y 0✓li? 3p .k4 - `' be_
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER l,--t _tr f,-,.asc'
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME iPHONE
`
kcinicio ,e. 125 G 72 2-Zrc)
MAILING ADDRESS E-MAIL
CONTRACTOR `"(S U '5 f h,c it Alit
CITY ) STATE ZIP FAX
t r..11---.--4.oi,-,.11-- ,?',r,"i_ ,I
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME a PHONE
�j/�,� Sm`fln X75 - 272 -zzSZ'
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) `./J >Ia ft-'C f- Ave.
CITY STATE ZIP FAX
/-24,A i"..,""--- 9 ,' 7 7
ALTERNATE CONTACT NAME: PHONE E-MAIL
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.
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 this
ofapplication.
/„f
SIGNATURE: .-----f„: DATE
PRINT NAME: -7n,.... >Ar, =t,--
Bulletin#l00—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
NI ECItANJ FIxTUtt �
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
PLUMBING FIXTURES
a
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
E.,Af'��1�ti'FOR�T <4 E '" r' d i T a„ryzp," ,'=U '� x"Y.
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes❑ No ❑Yes D No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
•
GARAGE ❑ CARPORT 0
��� ����, n1 g0a �'�'�: ,ria° Yk-�,d, ,+,.,.., ..._. —_ .—___.__.... —...._.
c� d �- esu� � 3 er
EXISTING PROPOSED TOTAL ---.---__----..-_.---�-- �.--.
Area Totals
-:g ::;.*NEW HOMES ONLY** _ :,. .. `�. 'i,
ESTIMATED SELLING PRICE$ #OF BEDROOMS
o v 1ERGIAL— TE 4'1 DDITtfl\
AREA DESCRIPTION ORM Occupancy Group(s) Construction Stores Additional Information
/1111111111ADDITION
Coti1 IERcIAL,-RE�IODFI fi NANT r`ti'RQ P?
AREA DESCRIPTION MEM Occupancy Group(s) Construction # of Additional Information
T .e ' Stories
TENANT AREA ONLY
,§51477-T
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application