14-104754 •
CITY OF PE M I'T,APPLICATION
Federal Way .. Rt
SEP 152014 -
•
PERMIT NUMBERl 4/ - // 0 7 5
/ (CITY F ED ERAL VMGET DATE C- _ ,1
CDS
SITE ADDRESSA-ti-e__
SUITE/UNIT#
318K0 ( E
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 6- 0
TPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING AFIRE PREVENTION
NAME OF PROJECT '�� /''
', ` d2 1 11-. ''s i u�k--IJ e.�t
PROJECT DESCRIPTION
�?
Detailed description of work to 2,-,,,b N-'p.S A l Fl i .- 32(+.4t S 1t"11n
be included on this permit only
NAME. PRIMARY/' PRIMARY PHONE
PROPERTY OWNER (.J i Iv IN k.....-. g /z.., "2-404.- 7S 1^?- 4L,,4--
MAILING ADDRESS E-MAIL
''' i VD 1 )CC / 64-. .A 7/i
CITY ATE ZIP
F6'.--be-V-A( Wit) KA
NAME PHONE
6-A4e a Pµ 1lc- z-53.is-7,-zosC
MAILING ADDRESS
1102 C 4 Niie-� te � 'i(M 1-1--Q...
�.-eM� ( y ! /lCtCONTRACTOR
CISi S ATE ZIP FAX (O K
(.', � �-bQ
C4 A -. 9& Zc1 z- 3 SJ 7r-2 iz
WA STATE CONTRACTOR'SLICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FIA, MV rZ /31 (4
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME - j PRIMARY PHONE
NAME"
PROJECT CONTACT .4 14 i LI EA--it.Ot4-s 2.3' , Gd6, , (Z ('Z
MAILING ADDRESS E-MAIL
(The individual to receive and t I 0 2 1, C?AM L--71
( 4 b tC P.....) 1 6.4�""TZr�ti`��=1�R2
res and to all correspondence Ye
concerning this application) STATE ZIP FAX
CI 1 L oL.. (AA 'i & 32'i
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$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 city as a part of thi appl ration.
SIGNATURE: .1'•i ,14/
�k DATE 9-(.�-r 4-
PRINT NAME: 4"e7r), / .% 5.fZ10-7
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
411
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 6 Oa.Crb
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(cas)
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(Eiectcic)
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
(0'14-:,74/;
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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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ROTOTAL
Area Totals
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ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
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ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
In Square Feet Type Stories
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TENANT AREA ONLY
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application