15-103257 •
CITY OF PERMITIIPPLICATIOI
Federal Way MEM) -;
PERMIT NUMBER
5l 0 , p JUL 0 7 2015
_
— — — TARGET DATE CITY or FEDERAL WAY
SITE ADDRESS SUITE/UxIY$
tOilaCf, SO 32o
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
i (D4 _ 9 ) se
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION f❑� ENGINEERING 0 FIRE PREVENTION
t'l
NAME OF PROJECT 1 . k \ o vt-f ��- 1111,3 S L )C.. c E
' t(Lt-ti o a kL&r L S to),...
PROJECT DESCRIPTION s S
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER ("l `C,k P01 it-f- 316 ) L-L-e
MAILING ADDRESS E-MAIL
CITY STATE ZIPN
el l h vet 1 kit inti- cG ►l ►.ct-._� j Iv , (36.o)teg t3 ~- 023'1
�O pn��r 1457 E-MAIL
CONTRACTOR �'`('�J
CITY STATE ZIP FAX
WA STATE CONT CTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
t,-M L1W W1. oa(P )n1. CP S / 19? / /;"
NAM
PRI Y PHONE�y' -7
Ei ' �.I.( Z (T I D '� l o S
APPLICANT MAILING ADDRE58 E-MAIL `1 2• Cl • '
e,
CITY STATE ZIP FAX
NAME r (PRIMAR HONE ,---
PROJECT
r
PROJECT CONTACT S\')€ t L v'4.:' t•1A-S"�1 LH-5J 53-3 4'7'75
(The individual to receive and ..3MAILING ADDRESS E-MAIL i_ (..A.-VVI.1 i
respond to all correspondence � o"-t_ Sine I e o ch
z
concerning this application) CITY STATE ZIP FAX
NAME OWNER-FINANCED
PROJECT FINANCING
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 az arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplie to e city as a pa this application.
SIGNATURE: DATE
7/77/.1-
PRINT
-PRINTNAME: a .i 3 t j
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK k
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 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
,tl;., ' / F lr!� ff ,.�/i,,/,�y��Fv frf iJ,�,%'ff'//`ifF//t/ /4j;// 4
FIRST FLOOR(or Mobile Home)
,,,,:..�,�,.i,.F/,. �:, ,rr�',. „x�. ,,,, ;;',>;,_ ,,f/,,,�„,. G.,�Y,f%'�./;�rl/'r/✓,ham. ., __.._.__.......____....___........__........____.._..___--____..___._.....---.._............_.._......
COVERED ENTRY
/
f
GARAGE ❑ CARPORT ❑
tilt rv,c ibe}/
Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
ray -
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TENANT AREA ONLY
PfZOJE�T Atf7LLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application