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10-102647 0 :th_q 7-- AkRECE - ! CITY °FPERMIT Federal Way juN 2 3 Z,,. SF MF CO ME PL DE EN P COMMUNITY DEVELOPMENT SERVICES j j1 CAT I O N 253-835-2607•FAX 253-835-2609 D L unuru.cituo((ederaC / CITY U CDS SITE ADDRESS SUITE/UNIT# 3 3 15-c_ G Av S PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 13) off_ o0 9 2 6 S 0 0 - a 3 y 3 TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING LitDFIRE PREVENTION NAME OF PROJECT �ry /� (Tenant Name/Homeowner Last Name) KI&'T PCII�I(�� Al' C/4, 1 IS LJ€' CAw► S PROJECT DESCRIPTION TEK)A.�3C'Zf+�1 v erv,�,�T Aool.�c- A bDi-n t J AL r l j2�.Q LM Detailed description of work to a r V l -5 To EX►SflV1(- F)f 2t AL?A4v, s(isrE1'v be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER FED caw.. 6-i aA.A � $S►a,1 A( LL( '/ZS" 2.1-6-/O.S'O MAILING ADDRESS E-MAIL o. Bak 11.09 CITY STATE ZIPQ ILL < ES�j ��1� t,\JA 1 V ia Y2- PHONE NAME& SQUAB StisrelM S 25'3 2- r(/-3707 G ADDRESS731217 E-MAIL CONTRACTOR ` ` S"7` CITY FAX Pv(i�lL�y STATEA �9g373 2S3 2 '2'7/'/ WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# CSQUASL963fR I /21 / 12 to-®c/a33Fld '©c NAME PHONE E-SciugiLeD satire w1 APPLICANT MAILING ADDRESS E-MAIL St.vIE AS A304/6 — CITY STATE ZIP FAX PROJECT CONTACT NAME , / PHONE (The individual to receive and M I KF" �f JIJ H 2s3 6'C_,c6'33 respond to all correspondence MAILING ADDRESS /� EMAIL concerning this application) SAW)L AS APot E CITY STATE ZIP FAX ALTERNATE CONTACT NAME: PHONE E-MAIL PROJECT FINANCING NAME OWNER-FINANCED Required value of$5,000 or more (RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE 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. SIGNATURE: it, DATE C! L " 0 PRINT NAME: A.4 1•-= AI/I.I/Ji4t Bulletin#100—April 14,2010 Page 1 of 3 k:\Handouts\Permit Application 0 S MECHANICAL'FIXTURES VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided) Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing factures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS(Conunerciap BOILERS FURNACES HOT WATER TANKS(Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING FIXTURES Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing factures to remain. BATHTUBS(or tub/shower combo) LAVS(Hand writs) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS(Kitchen/Utuity) 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? 'oXiYes❑ 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) EXISTING PROPOSED TOTAL Area Totals **NEW'HOMES ONLY** ESTIMATED SELLING PRICE$ _ #OF BEDROOMS COMMERCIAL—NEW/ADDITION AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information In Square Feet Type Stories NEW BUILDING ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information In Square Feet Type Stones TOTAL BUILDING rr TENANT AREA ONLY 3 1 I gi efF)tC Tom',:.. 2 pC�r)(4� F►lsfi Fi,,: / ALL cc SEGa,aD F<eof� PROJECT AREA ONLY Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application