16-105578 „,A
RA PERMI'APPLICATION
CITY:',F
Federal Way NOV2015 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
2 2 253-835-2607+FAX 253-835-2609+permitcenter{acityoffederalway.com
CITY OF FEDERAL WAY
PERMIT NUMBER a _ / 0 S 7 ' _ g iTARGET DATE `
SITE ADDRESS SUITE/UNIT#
2010 D. 311L/ 7 .) 6 E"Er d. A 9
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ L/ZO0 .tc 2 & 9 3 3 0 - v 6 7 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING D MECHANICAL 0 DEMOLITION 0 ENGINEERING 'FIRE PREVENTION
NAME OF PROJECT GARAGE 7—Q-i i - UN 1 r A 9
PROJECT DESCRIPTION //��
Detailed description of work to FI 2E , sLA2►v..- ANoAri c,P1/4--r1 SAG
be included on this permit only
NAME PRIMARY PHONE
GARAGE Tt"v ri►
PROPERTY OWNER MAILINGADDRESS
& al-4 471-1 1 s_- E-MAIL
GGy %1 . f
CITY STATE ZIP
le -Ce-AL, kW 16 A 9t 0C)3
NAME , PHONE
I' 1I 3Y EEEcrl�re, 2,53-$S9- 2060
MAILING ADDRESS /��) / E-MAIL
CONTRACTOR lig 0(0) 'v 6T r"/"��' ' ` 0 / SelAcoa 1�1i428YE1Ecr -IL
CITY A u f3“IAV STATF H ZIP !2 CO I FAX
G S3- �-23i 3 .C OT•!ti”
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
IL i Q 61 E.i ®7 7 r3/q I 15/ 17
NAME PRIMARY PHONE
SAME M 00741-RA C i iP--__
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME cI ' / A' / PRIMARY PHONE q / G
PROJECT CONTACT V W/J LE 1 Moak/ 253- 31- `-/23 p
(The individual to receive and MAILING DREss / E-MAIL/
respond to all correspondence Lie /V v 7--- Alto !0 1 cst 4 k letay&zero,
concerning this application) CITY /amu Uu 1� STARE ZIP 9�m�/ FAX i CC-1)4"—
AVG( B 753 ( 3
NAME
PROJECT FINANCING ❑ 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 city • a part of this applicatio
SIGNATURE: ' /r• ' /L.- / DATE ii—Z/.-1/9
f
PRINT NAME: S PIA N ` L id H AA
�� Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
• 0
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 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
$ yZOO.°C)
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FI 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)
IAD. LO R
COVERED ENTRY
1E
GARAGE ❑ CARPORT ❑
S, 1
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
Area in Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
Square Feet Type Stones
INN
s
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
TS AL BUILDIN 3
TENANT AREA ONLY
T•:A OILY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Pertnit Application