Loading...
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