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16-106001 , _ 4. trews) �r ��� PERMIT APPLICATION CITY OF Federal Way � D ywA ' PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325 `�" 253-835-2607+FAX 253-835-2609+permitcenteraacitpoffederalway.com CDS PERMIT NUMBER I (42 O O O ' -co TARGET DATE SITE ADDRESS SUITE/UNIT# ;Sync ri. tivEs, PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 53-To g c2 cc o 0 - ® c2 Cry C TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING FIRE PREVENTION NAME OF PROJECT # fyyn5TiZEF1 6/,frizz 1`AJT6/Z vg.A� aQ©1( PROJECT DESCRIPTION /�'13�lFyTFI gk15Tt,Ufr cil5TE I 'To yrl.Go(r►m3DATF i/-16 Detailed description of work to /YEW t aillS li' G /LIIUls3 be included on this permit only NAME - _.PRIMARY PHONE 454 reowry PROPERTY OWNER MAILING ADDRESS E-MAIL 1000 f/M/1I/ S1T(,qvt 5T E SoaS -/newpvr7lez'reuf ,6000 CITY STATE ZIP 5h(1 ritE tAli4 gria l NAME PHONE .furl ' Fief Ss/Ern s '0 -D67-S MAILING ADDRE / E-MM,, CONTRACTOR #36S2r�v6 jg /(`I,.i -e.6,9A CITY_,_, STATE ZIP FAX * oi►A wg l8wjg "3' 471)6 ya35o WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# e irh,3f360T /2 i 3i / 1G NAME PRIMARY PHONE 6ni'rN P/Pei 5)#5 � " APPLICANT MAILING ADDRESS E-MAIL i, !i ie I/ CITYSTATE ZIP FAX r' /) /1 e 1 /• ii NAME PRIMARY PHONE PROJECT CONTACT (� (11^E' i' ,/ �� �� MAILING ADDRESS E-MAIL d/ (The individual to receive and t/ re eI respond to all correspondence concerning this application) CITY i/ ,, STATE ZIP 7 FAX ,,, /, i/ " NAME PROJECT FINANCING ❑ OWNER-FINANCED When value is$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 the cit as a part of this application. SIGNATURE: 1, DATE AD'00 Ks PRINT NAME: TE FF Sim(T1-f Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application • i 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(commercial 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 dor Tub/shower combo) LAYS(Hand sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS)Eitchen/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? Of,cll 6 p'Yes ❑ No ❑ Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE ar 6 .. AWN41,74.1 AL' FIRST FLOOR(or Mobile Home) COVERED ENTRY • GARAGE ❑ CARPORT ❑ — EXISTING PROPOSED TOTAL Area Totals ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL—NEW/ADDITION AREA DESCRIPTIONIMMI #of Occupancy Groups) Stories Additional Information ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION "WM Occupancy GroupConstruction #ofs) .e Stories Additional Information tF TENANT AREA ONLY /O..S Q gyp... t ti , Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application