16-101670 • •
ED
CITY OF T°.. APR 0 "2016 PERMIT APPLICATION
Federal Way
CITY OF FCEDDSERAL
WAY
PERMIT NUMBER / I ,., - / 0 I /llllll� 70 _ t
lY l iEi TARGET DATE
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ �J0 , .� t ij 2' 5 - 0 0 ` , 0
TYPE OF PERMIT ❑ BUILDING D PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING XFIRE PREVENTION
NAME OF PROJECT GDS t C _
PROJECT DESCRIPTION ,�.,Q
Detailed description of work to `C)cey �/� ( r �ca
be included on this permit only MA
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NAME [�, C PRIMARY PHONE �✓"` k��
PROPERTY OWNERMAILING
C aL C L 1��b \D O\ J ,r\Z 'A ctQ(d
MAIL0 0ADDRESS i l' V n 1 3) E-MAIL
CITY VV STATE ZIP
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ONE
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M /ING AD RESS E-MAIL
CONTRACTOR v \2-\' �e5s cr0 •cbh'7
c \1\\ GY-eek, 1 STATE
- ZIP gO g2Ax
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME PRIMARY PHONE
• .me as cvey-I-raG-tDr
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME
` . -1/ PRIMARY PHONNE1 p�
PROJECT CONTACT CX\ \� lQ (YOW 1� ZS'40 )'7(069
(The individual to receive and ING ADDRESS ` E-MAIL
respond to all correspondenceii2 )( \� \2DCY 1 mice crowrrfr.cowl
concerning this application) CITY
I ► \1 \\ LY- -2� uok z1 V D S�IP FAX
425 L4 S 1-00/5
NAME
PROJECT FINANCING VI., 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 the city as a part of this application.
!2 , / L I J6
SIGNATURE: �I�G�`-ti DATE �j- /' /
PRINT NAME: J1sJ1Cc RDLin sCfl
Bulletin#100-October 26,2015 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 relocated as part of this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS .2. 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(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes n No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT ❑
OTHER(describe)
^
Area TotalsEXISTING PROPOSED TOTAL _--
**N W HOMES ONLY*'
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-October 26,2015 Page 2 of 3 k:\Handouts\Permit Application