14-100031 CITY OF 4111161, P2C � ' PERMIT$PPLICATION
Federal Way
JAN i'032014
PERMIT NUMBER jr �1i' F - io
/ E�L J��^� / _ r--
/ 7' 111/000' ��JJJS 1/ 1 TARGET DATE
SITE ADDRESS ( rr � �/ {‘ 7g 00 3 SUITE/UNIT#
'2o 0 Sowok„_ 7)44 S6, vlwt,( C qt 0- ec e l-Q1— l� o, y C_ 4
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# {
$ 6 4 0 o _
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING TIRE PREVENTION
NAME OF PROJECT -3 p rJ A r ,M E.1_ .
.A Iv IV e S P 21 .i k Lc/z 5,Y S`6'(_ ►"l
PROJECT DESCRIPTION C 1 L t� ..f_ $(J r l n L r may S -e vi. `G'o cjo[ V e y �`^� �-
Detailed description of work to W(J U.J- Lt..V e- 00'1'0(..-C wlio¢>L t Gr„ le? Cy Q
be included on this permit only cot O re,Q, 1� c ace_ l „..0 v r 4vw 6Lre O c (^ „, l(evx e.:1-2_0,-,(1,..2,
NAME PRIMARY/' PHONE /
PROPERTY OWNER ?eJ- cr7o '�(p q - ZSZb
LING ADDRESS E-MAIL
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CITY
%erQ CA./
ZIP
NAME G w' A '4L PHONE
5 C S 253 v $ z0S
MAILING ADDRESSE-MAIL
CONTRACTOR l E7 SL U Q S l VSiM14'I,.,fl f E--.GOtevt
CITY STATE ZIP F
Ta,GpkAA,a, WA 92
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME i PRIMARY PHONE
V - Br p t2Ga, 1-w6 tn--3- Zs-26
APPLICANT MAILING ADDRESS E-MAIL
sck vv.e— as 4 (O✓e--- kAli_sktpee ���oA,�>",
CITY STATE ZIP FAX
NAME - PRIMARY y r PRIMARY PHONE
PROJECT CONTACT kJ \GV< (Jr Q.SSI S 1' y 1-1-3 1--Lti D: ,-S-.
MAILING ADDRESS E-MAIL
-------(�-kte individual to-receive-c�nrt----- 7 h- -
respond to all correspondence TI V Co,tS V �- i'n cotA A S t^',i tV re_• c 0
concerning this application) TY STATE ZIP FAX
-mol�Q,c., w Az
7 w A 'i 8 L,-IA
NAME
PROJECT FINANCING gv 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 s claim arise out of the reliance of the city, including its officers and employees, upon the accuracy of the
information sup lie–to the city part 'this application.
SIGNATURE: DATE 3 . L. G Lt
PRINT NAME: VY/5L �� V3`V
'3u11etin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
F
•
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(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT / $
Indicate how many of each type offixture to be installed or relocated as part of this project. /o 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 IREAKERS
DRINKING FOUNTAIN SINKS(Kitchen/Utility) WATE EATERS(Electric)
HOSE BIBBS SUMPS WAS. NG MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PU YOR SEWER PURVEY•' VALUE OF EXISTING IMPROVEMENTS
N'
EXISTING/PREVIOUS USE LOT SIZE(In Squa eet) EXISTING IRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING P: *POSED TOTAL FOR OFFICE USE
FIRSTFLOOR
(or Mobile Hom
e)
87/,7,/,16,,/'..„I / iSECON 1L 3R/ /s//, 4/// ,lr _..... .___._...__........_._..............__...
COVERED ENTRY
/
GARAGE ❑ CARPORT ❑
OTHER'(describe)
EXISTING PROPOSED TOTAL
Area Totals
DMFS ol9LY'”'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/AybITION
// Construction #of
AREA DESCRIPTION
InAOccupancy Group(s) Additional Information
quareArea Feet
Type Stories
ADDITION
COMMERCIAL-REMYIODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUliUtRO. ,�
TENANT AREA'ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application