17-103086 �► PERMIT APPLICATION
CITY OF PERMIT CENTER+ 33325 8thAvenue South+ 8003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +per r is c e 'a 03a-6325
PERMIT NUMBER _ I ® o 8 (✓ _ JUN 2 7 2017
- - TARGET DATE CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
SITE ADDRESS SUITE/UNIT#
?j20z5 FAGVIc HWY
PROJECT VALUATION ZONING ASSESSOR'S T5AX/PARCEL
$ 3ZoS � �� -
(J
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING 'IRE PREVENTION
NAME OF PROJECT C/_ � ., 4
2Ns f'r 2- k:1-04....) F sc 'Q1"e 5516.4 sYst-e' s
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
061.4}`' -F:i
PROPERTY OWNER D 3 • E-MAIL
pat c
Co
CITYSTATE ZIP
fedarrt/ w4Y we949o03
NAME 1t re PHONE
�A7
MAILING ADDRESS '�-1 Hwy E-MAIL
CONTRACTOR 30/3 30 "o RY4r G am'P r�•«M
CITY STATE ZIP FAX
Se41ft 879
WA STATENTR�TOR'3�CENSE#PS EXPIRATION DATE� FEDERAL WAY BUSINESS LICENSE#
444
NAME
/z T S h /� .. .. PRIMARY PHONE
Aa G w
APPLICANT- MAILING ADDRESS E-MAIL
SGµe o4S ccbt,
CITY STATE ZIP FAX
NAME - PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 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 tot ' , a- this application.
SIGNATURE: DATE *Z 7-1"9-
PRINT
_
PRINT NAME: Z)/ � SC i4
Bulletin#100—January 29,2016 Page 1 of 2 k:\I-Iandouts\Permit Application
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(or Tab/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 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?
❑Yes:❑ No, 1�Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
•
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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' FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE ❑ CARPORT ❑
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area
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onstrr uction #o
fAREA DESCRIPTION Occupancy Group(s) Ad/d�.,itirion`�;,'✓al I'ffnfform;.,rJ`. at�r�rio
nSquare FeetStDries
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ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Square Feet Occupancy Group(s) 'Type Stories Additional Information
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application