16-104279 RECEIVED
41 PERMI'IIAPPLICATION
CITY OF AUG 3 a 2016
Federal Way
CITY OF FEDERAL WAY
/
PERMIT NUMBER 6 _ / u y`x7 , - p
TARGET DATE
SITE ADDRESS SUITE/UNIT#
►3W 5. 32P yke-c4 A9
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ Zip G? t 5 (2 0 S v - O o --
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING XPIRE PREVENTION
NAME OF PROJECT ' LOQ ICA c-V- v.1'^-47
PROJECT DESCRIPTION
Detailed description of work to ADO ! (Ze\Cc i t. en. c �c 5rrtsk..cf 11.e.44 440, ✓1e.✓
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER HM-5C 1WeSri44 emr PkoPk2r e t--C• -'
MAILING ADDRESS E-MAIL
O-
60/c A70$
CITY STATE ZIP
NAME PHONE
Al'it\o Ft tI {neer c7Lo►.) ZS3--`/26,-22°►t>
MAILING ADDRESS E-MAIL
CONTRACTOR 70' -7 0-74". +4v
CITY STATE ZIP FAX
1A-00A—Ar '1812`F 253-922ts-4?
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME 1 � 1 PRIMARY PHONE
//'{{'' k641 r ► Cc)r'If...0 Ix •
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT OV"-•. 25 3"BIOS'% roo f
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 2101 70'1' AN" `tlN.AGXt -t oic�re•Ccw
concerning this application) CITY STATE ZIP `SAX
C-Ow A v4 SAKI2
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
Required value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 th ty pa of this application. C
SIGNATURE: \\ Ti�-- DATE p-21—
PRINT
G1—PRINT NAME: J0\4%� ✓o+C��
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocat-e • part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREP e' INSERTS HOODS(commercial)
BOILERS •'NACES 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 •• - • this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWAT r .' TEMS URINALS OTHER(Describe)
DRAINS a ERS 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 F FRE 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
',4410ArdrAl
................................................................................................................................................................................................
BASEMENT
.1 ,1 .V .. an,. . ._.btnll*1 noma rpt��°I��: _......... .... ......... _..........
FIRST FLOOR(or Mobile Home)
SECONDFLOO 1 M
COVERED ENTRY
................................................................................................................................................................................................
DECK
- ; . . .rte_ -.,et.( K_
GARAGE ❑ CARPORT ❑
................................................................................................................................................................................................
0THER(describe = '
EXISTING PROPOSED TOTAL
Area Totals
glaktireAL,
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
}} in Square Feet Type Stories
ar..,. -NEW BLDNG -
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
AreaConstructionGroup(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDINGr ( x r *t�M.,. r € ,
TENANT AREA ONLY 000 itZ ra1/4
RQJECT AREA ONLF `x Ia f v„
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application