14-101767 CITY OF ' PERMITIAPPLICATION
Federal Way APR 1 2014
rOFFEDER/AL WAY
PERMIT NUMBER / _ / c /�y 1 _ rp /
l��ii"' TARGET DATE C
SITE ADDRESS SUITE/UNIT#
s.324 5s 6131 / c s t 3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 6 i 4 0 P `t" 6 a_ 0 - 0 ,2 4 D
TYPE OF PERMIT ❑BUILDING ❑PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING AFIRE PREVENTION
NAME OF PROJECT L.e.N i0 A fC-
PROJECT DESCRIPTION ��"\OM T C„A T3Di i, .lo G X'35""t-LSC. F-'l.i z ALP-Oriel
Detailed description of work to •S'V.S t r A'x F o k. 'T E 1.,t► -R LL L11L.t?
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER C-i 3.0 18k.i0FSThes. LLC
MAILING ADDRESS E-MAIL
10036 i..ici-1ITEHIi S _T
CITY STATE ZIP
LAS kircc,As Nv 8`i ty I
NAME, PHONE
1' ACI FIC_ Limn-E->) .i 4 06"3 ,7q_1-0470
MAILING ADDRESS E-MAIL
CONTRACTOR Nria,Liti SLI i320 86-141...IL EL item t-1iey cot)aIM‘inckt8wi-poi
CITY STATE ZIP FAX
Mit.. Cra v., toil- q,Bo) D ax, 8;) ' q9 z
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
PAC .F Lc 8€1a LLi ? / i 15 sln-i4 tiv‘(4)0-vb--3i-
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
_
�.
NAME .. . .... .. .. PRIMARY PHONE ...
PROJECT CONTACT O i iStlAVJ -1'n / ;OS 3 -1Ct 1 f 7a
(The individual to receive and MAILING ADDRESS .^, -
respond to all correspondence ?Y 1Q C/is4 i aw l�7gAti. . EUL(t 11' otts-/ row-rnA V ciccirCcat. Nl1
concerning this application) CITY STATE ZIP FAX l
INA I LL Cf22Et L LK)it 4/8 11) t O ax, 8.x-540 I
NAME
PROJECT FINANCING 0 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 to the city as a part of this application.
SIGNATURE: rn a'IN.1(V t\ti a. DATE a`I "I'l -1 U
PRINT NAME: a]. . ; "'
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 offacture 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 factures 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
EXISTING/PREVIOUS USE LOT SIZE)In Square Feet) EXISTING FIRE 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)
SECOND FLOOR
COVERED ENTRY
DECK`
GARAGE ❑ CARPORT ❑
OTH R(ret
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW Istsuomer:
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetType
man v n ....
TOTAL BUIlDING
TENANT AREA ONLY cc,O
PROJECT AREA ONLY 5CieltO -;
Bulletin#100-January 1,2013 Page 2 of 3 k:\Handouts\Pemut Application