10-103604 •
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Federal Way Detailed
COMMUNITY DEVELOPMENT SER1b;QCt toepi C A T I O N AUG 2 0 2 010
253-835-2607•FAX 253-835-2609
i INS',ilVelle1&ZQ:WOSJ.CCII By /^—v
_ NW CITY OF FEDERAL
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SITE ADDRESS N]♦C�Wr I 1 CDS SUITE/UNIT#
-36 Q2 t lCiI C Mf7 A --(05-
PROJECT VALUATION ZONING / ASSESSOR'S TAX/PARCEL#
cjzocr --
BUILDING
TYPE OF PERMIT CIPLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
(Tenant Nome/Homeowner Last Name) VIi !
PROJECT DESCRIPTION t-'I Fr 41.4e41/ ,D�C j —' C...2-) 4 p A-,
Detailed description of work to _JCS/S77MI•-- " ' -, 7i ';71
be included on this permit only
NAME .� PRIMARY PHONE
PROPERTY OWNER f:-.---.0 �L Yv 647f-e'er�il,...)c
MAILING ADDRESS E-MAIL
/Cvy1 / (-f- 1 A - Se,rF i32
CITY STATE ZW
r� =i-__vv_ f' 9go� o4
-
�—
NAME _. �' - -. PHONE
i I C__ h, ✓__%_ /t2i -i iF W..) / c-707MAILING ADDRESS pQ( / E-MAIL
CONTRACTOR / /�
CITY FAX
-- 47X V1(4.ST• 4�f zit-;'),g /4,1 74' 74-.— g/&---0
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PA-1 F,i= A-1 71 MJ 06,0/ / to&-to3 80
NAME 1 ! PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS ._ E-MAIL
concerning this application) �•-'
CITY /./.f TATE ZIP FAX J
ALTERNATE CON NAME: PHONE - E-MAIL ''
PROJECT FINANCING NAME
,r-- _ OWNER-FINANCED
Required value of$5,000 or more �`\
(RCW 19.27095) MAILING ADDRESS,CITY,STATE,ZIP CCC 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 taws.
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.
r
SIGNATURE:
DATE /7�C0�0
PRINT NAME: o7rAyi '
Bulletin#100—Apil 14,2010 Page 1 of 3 k:\Handouts\Pernvt Application
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VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture to bdinstalled 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(ces)
COMPRESSORS GAS LOG SETS REFRIGERATIO1I SYST •
DUCTING GAS PIPING WOODSTOVF '
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Indicate how many of each type of fixture to be installed or relocated as part of this,,froject. Do not include existing fixtures to remain.
BATHTUBS(or Tub/showermbo) LAVS(Hand sinks) TO ETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS INALS OTHER(Describe)
DRAINS i SHOWERS ACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Hitchn/utsiq) WATER HEATERS(Electric)
WASHING MACHINES
HOSE BIBBS SUMPS '? > .:::::::.::::•:::::::::::.....................:..
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CRITICAL AREAS ON PROPERTY? WATER PURV:YOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
R $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet( EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR (or Mobile Home)
COVERED ENTRY •
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GARAGE 0 CARPORT 0
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ #OF BEDROOMS \
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Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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ADDITION
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Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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TENANT AREA ONLY
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Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Pennit Application