17-103502 CITY OF 6�► RECEIVED PERMIT APPLICATION
20
JUL 2017 PERMIT CENTER+ 33325 8th Avenue South +Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY'D'Eti1ELOPMEKf
PERMIT NUMBER / _ / 0 3 5 0 - TARGET DATE
SITE ADDRESS
/)/ ^ SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 000 — —
TYPE OF PERMIT VAUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT u 411 1j
PROJECT DESCRIPTION tie(ta-e ��
Detailed description of work to
be included on this permit only
NAME
Mk , i
d PRIMARY PHONE
G/ n,7 /4-5
PROPERTY OWNER TILING ADDRESS 14y O , E-MAIL
CITY y� ./�� STATE ZIP ^. Oma/ /
. ... ... NAMR €Sf
'"' /24S PHONE J ( G IF/
MAILING ADDRESS MAIL
CONTRACTOR pe e L im wikk Ail,f/c
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME
kr4Z/1 ,155 (/ PRIMARY PHONE
u�
APPLICANT- MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME
47;Ac/ l� yG PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS jj E-MAIL
respond to all correspondence
concerning this application) CITY /! STATE ZIP FAX
PROJECT FINANCING NAME // G, IlY OWNER-FINANCED
When value is$5,000 or more MAILIN/GV ADDRESS,CITY,ST E,ZIP/� PHONE
(RCW 19.27.095) 5 //_ vc,n c (Ve geAi-/-oA' u./' yL IS
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 de ens. of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where such clai arises out of the reliance of he city, including its officers and employees, upon the accuracy of the
information supplied to t city as • ••rt of this ap lica
SIGNATURE: t DATE 7—/
PRINT NAME: / k `Ay/�/ rf[,/
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offixture 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 PERMIT i V � Y IviollJG '�cR
$
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 ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
, "4"4-' I,.4 /o,✓ff r ,e /fVd f! rr, ,f ":„40W/::,...4',e,,,,,
e/., /� . < ,,,, , >� ,' /1 ' ' Yr ,/r - rr r � 'i ////,,,e r!/r ,fi' / k0- jr" ,,, ,,4„/" , ;, -,
....__._....._ ............................... ........_.......__......................_.........._.._.._............__._..................._.
ollyFIRST FLOOR(or Mobile Home)
'` s �" � -..??4,,,
!! , � � � r �/fir ,// / / `, / !i- f/ , of `/ . # r"� ##,. . ; A, l /,.!!!,,,,%,4 ,, t/
• _........................................_.._.............................._.._..............................._.................._..................._................
. __.......__ ..............._...__.. .........._.___.... _................._...._._._ ........._.._..
COVERED ENTRY
rlj'/ r ,7
!,'/#':#####l"", rr ./ � ! / / , ; ; v , ,:z ','r ,//ff ,r
GARAGE ❑ CARPORT ❑
S //a a": i r/ t /f �, /� ¢tv Fid/ r/ ././ ,/`�, ,
f% ,,40.";,4,,,,,,,.„„"s„;sr r ,!,?1.1.*,ve,-:r,`!,`vx""< ls ,4„ i/,, r,, ,. ,.`O v.,'./ "',.
Area Totals EXISTING PROPOSED
TOTAL
,; ' % iir! // / , . , ' ! , ! �,A ,
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL-NEW/ADDITION
Area in
Construction
� #ofAREA DESCRIPTION Occupancy Group(s) ,� , Stories
I Additional
nal Inf
ormationaarP Feet
,/ /t /l,9;'ff r,",:n v/, ,y',, r. .4/2/.4i
"rr,/,,. „..„44,,,,,,,,,e,„-ie,f e,4„ � f/, ,,/' i,.„4„� `,yre„r,,,,,„:,,,,f,/ , f,y / 4, t5'fft� ,' '// /J , ilf . .r /4/,^4,S14/0;),4 ” .Y.': , f rF./.t,x41-&-Y/4 8 ,r� /, .,-,07/?;04.1 f - / IADDITION I ( (
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
S uare Feet • .e Stories
TENANT AREA ONLY
i /'/ , ,ry � g /;e:e rt r ` "r'k'''/ �/ !,44;;;;A4-;
/ /s''r ! fi / , ? , t " / / Ala�1 ! ; ! / �1" �/.!, � / /f/ . ,,n , 4,/,`",/,/,','--/ , „
'.
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application