16-100581 111161, .
CITY OF 41116 PER : ' PLICATION
Federal Way 61
( ^ (� FEB 01 2016
PERMIT NUMBER 1 9 _ U L/(� c 5 I P ?CITY OF F DERAL WAY �J I P
GET DATE
SITE ADDRESS SUITE/UNIT#
. V >S Co. \"k 1-.\-; i 0 0
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ rte 1 (0 (1 _ 02 --)
TYPE OF PERMIT 0 BUILDING 0 PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERING E FIRE PREVENTION
NAME OF PROJECT
V�V
\- -, d 1�-."A-1 0 Irk
PROJECT DESCRIPTION L C“ -c_ el 4.41 Iv ex r ,c4.. \0 C Ca A 7`b1 n
Detailed description of work to ', i \\.9 C v' T) '(i v)- . 4S c'1 rt c1 '.51.1 c)\(j't t L7
be included on this permit only
J
NAME PRIMARY PHONE
1. i C) d,ec-- YlVA\, 4tiJ S `''z 5- --.c.3 5"?`i 5
PROPERTY OWNER MAILING ADDRESS .
E-MAIL
.C.." rL\ )'«1 N E j ,\-a 2-kAGc
TY STATE ZIP
___A\-e u .1v, ,4y;f
N 9
-.....-....,i,e., G1"c, ,a.1 ��CC � � 0\a„ u\ �.�._-c_ `n-Lie`- (3x'33
MAILING ADDRESS 1 ) E-MAIL
CONTRACTOR p 0 „, \ `� f cot I : 5 c. 4e cl- Te.e -l' l;
CITY STATE ZIP FAX
,\.\ (C-?•`u, r' e
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
L-� l_ . '1eG50G 11 / -3 1 / OIc, 'Z0-I '- loL, 07,ccii)L
NAM PRIMARY PHONE
LACI S \> �Q i 2QC -97, \- 31-zc
APPLICANT MAILING ADDRESS E-MAIL
)UC> :� ��1��G, 1 rZ� C-"t 54P \ec.AI`0=recA,..(3V`,
QITY STATE ZIP FAX
NAME „..._., PRIMARY PHONE
PROJECT CONTACT Av-,,-� 0,-2, .A v t;, e-.
(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 to the ci a p his application.
SIGNATURE: , / DATE 7/ /( e U / C
LPRINT NAME: CA r s A:j')4-c,- i"-----)},, ''
Bulletin#100—January 4,2016 Page 1 of 3 k:\Handouts\Permit Application
• e
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(cos)
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 Tub/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
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES any**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 4,2016 Page 2 of 3 k:\Handouts\Permit Application