14-104399 10 CITY PERMIT APPLICATION
Federal Way AUG 2 7
CITY
r 2014
PERMIT NUMBER 0 DCv, 1 / _ Fl
/ _ �11 I TARGET DATE C....s.**** *----....s_ ,.„../
SITE ADDRESS SUITE/UNIT#
I 'eT -\ €-.
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$,440 qlgiO --+- '1C7V1 X20 _ 0100
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING WRE PREVENTION
NAME OF PROJECT ( )6 1 /� ( LW-i264
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PROJECT DESCRIPTION b t. yr 1C `'[vtc26iJ/I�rCQ,l t•I IL r nit/ tt ii �
Detailed description of work to 1 4' 5 ,L 2.0 OCA )i t t il._L Si N�t. Ei C "ct2
be included on this permit only � -. j ¢y )t t c
PRIMARY PHONE
PROPERTY OWNER � r . f � WJ�nST
MAILING 2J271. I U �'�2,U1 sem- 1-141 G E-MAIL
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STATE 2,%col
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, 0E PHONE
CONTRACTOR 1NMR7 3 - `"`e' "O C Kk.3 *02 SIC "c I(4>C Fi ;+�
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STpt2itt CONTRACTOR'S
tEXPIRATION DATE FEDERAL t2.1O2( Ov'M.-
NAME �gatp - 4: nine /� ( C T �.T1S0
APPLICANT Tor
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FAX
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PROJECT CONTACT uL/ [C �! /` –+AGK. �� I f��J
(The individual to receive ande 4. �( . 14,_ Nl Li 4 t 12 ' 4�, 1 EIJ�{�/..,
respond to all correspondence 71.64.(.34,44„,,,,,
'LJ`�1 -�"'�I [� Wr 1
concerning this application) CITY ST TE ZIP FAX
C l� � � . 2 72- �.-710()
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 this application. l
SIGNATURE: ,� ��4� - DATE ( •21 t :.-
PRINT NAME: 4 11.i i p I c �il� l .rJC ,
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK it
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(orTub/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(Ia Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
x ❑YesNo ❑Yes ❑ No
•
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOII F`I OOR ("
_ ,ray r,� d( i •, r� i
COVERED ENTRY
.........:......................................................................................................................................................................................
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1�,'ES . � i j� gw yi�,� i iId Izh i�j�Nl I'
GARAGE 0 CARPORT ❑
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COT ( escribej IP . c
EXISTING PROPOSED TOTAL
Area Totals •
•s R *'NTEW HOMES ON1LY'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area ren Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
il, „' .i.
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Tie Stories
,�`.` r�Ei .A ,ties A„. i - r—a2R
TOTAL 3UILttIN(i ''
TENANT AREA ONLY
ut
igiiq�i A`�r .:. - , (iam i hPtN4 s irij . 'I l G, ter, ,
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application