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09-102776 RECEIVF' - ©_6 7 ? FederalWa PERMIT s� S F CO ME EL PL DE EN y UL 2.2 2APPLICATION COMMUNITY DEVELOPMENT SERVICES 253-835-2607•FAX 253-835-2609 - - wvw.dtuoffederalwau.com 111 OF FEDERAL WAY • SITE ADDRESS y 1 L SUITE/UNIT, SL ASSESSOR'S TAX/PARCEL#1 D 4 2y 3 I� t. L. NAME OF PROJECT (Tenant or Homeowner Name) t) , ❑ BUILDING 0 PLUMBING 0 MECHANICAL TYPE OF PERMIT 0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING FIRE PREVENTION PROJECT DESCRIPTION C `' Detailed description of work toS �� r� 5 l� f c�U(a. o e�� "F Jx� be included on this permit only ey S rtv � ,.., . y , ... . 1 , .„, . . . . N1 NAME PRIMARY PHONE PROPERTY OWNER i r ct ( ) - MAILING ADDRESS,CITY,STA'T'E,ZIP E-MAIL 3i141 1 0' r� k'a. OWNER IS ALSO: ❑ CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT NAME PRIMARY PHONE $ ,, {l ( ) `1 - ®j CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP `` FAX � 2Z1 te ��. c 4NE ( ) - WA STATE CONTRACTOR'S LICENSE► EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 0 $ k U. - LI ) n •..� / ° , NAME PRIMARY PHONE APPLICANT a..= t,'t <� ?i"+ 17, ( ) - MAILING ADDRESS,CITY,STATE,ZIP FAX ( ) - PROJECT CONTACT NAME /� PRIMARY PHONE (The individual to receive and )•. (.Ni - ( ) ' bb respond to all correspondence MAILING ADDRESS CITY,STATE,ZIP FAX concerning this application) r, )) et t ( ) - ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL PROJECT FINANCING NAME 0 OWNER-FINANCED Required for projects with value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE (RCW 1 9.27.095) ( ) - I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating construction or environmental laws. I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied' the city as a pgrt of this application.A4, SIGNATURE: — DATE '-)IZ 2- !C i\ PRINT NAME: I' C` t•-vv,. Bulletin#100–4/17/2009 Page 1 of 4 k:\Handouts\Permit Application 1 40 MECHANICAL FIXT Z `T, P . Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) Indicate number 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 Indicate number 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(xitchen/utility) WATER HEATERS(Electric) X HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES' GENERAL INFORMATION PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS $ r,l; EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑Yes ❑ No ❑Yes ❑ No RESIDENTIAL AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT - ------------ ---- FIRST FLOOR(or Mobile Home) SECOND FLOOR -- --..� COVERED ENTRY DECK GARAGE ❑ CARPORT 0 OTHER(describe) EXISTING PROPOSED TOTAL Area Totals **NEW HOMES ONLY** ESTIMATED SELLING PRICE$ # OF BEDROOMS 8 ; COMMERCIAL- NEW/ADDITION ,,�i�.. � t.��Tye,��?,,..X�•�. F ,-n_ .�c. •.,. AREA DESCRIPTION Area Construction # of in Square Feet Occupancy Group(s) Type Stories Additional Information NEW BUILD G • ADDITION ~C ! tnM 1}EL/TENANT IMPR VEMENTS AREA DESCRIPTION Area Construction # of in Square Feet Occupancy Group(s) Type Stories Additional Information 'Mtn BUILDING »„ TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application