14-101717 KEIVED 1III
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Federal Way
A. APR 1 5 2014 PERMIT APPLICATION
CITY OF FEDERAL WAY
CDS
PERMIT NUMBER / v _ 10 J -71. 7 C-- ,__D
_ - ,-
TARGET DATE
SITE ADDRESS SUITE/UNIT#
33 q-S$ Pfii s. i_e
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 12/ 32-S.0° P\O clturlfrL 9 2 G S 0 d _ c) 3 e-/- o
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING g FIRE PREVENTION
NAME OF PROJECT (.e,1,14r- 712' Q C'ea Po"4 4-ive,,1-- cat 4-.7,A-is
PROJECT DESCRIPTION (A/o ie. oYt G et, SPri.4.etcis c,,--1 Cx,.s�':'t9
Detailed description of work to sr r,A/C/, !c YS14e-/"1 )4r, QC CeSN+aciai A e_K/
be included on this permit only Te ^f— �4 /I's a aeloi ce,V�j5
NAME PRIMARY PHONE
PROPERTY OWNER `O'(,c,'42_ /'^14.5740-1-_-.-S' l:.L -
MAILING/ E-MAIL
2 O 35 4 As- $�•
TY
STATE ZIP
4S V Pf aS N!/ 89/f''/
NAME HONE
(r„/,-A r` Jy,59e_t5 P2-S3 /Z.( /STD
MAILING ADDRESS E-MAIL
CONTRACTOR //O 6 S 1,1-11 Ave- n vcrn e!'Ens)'r�4 F'M.IaM
•
CITY`ie t sevto� STATE Vef ZIPL q�!p -2.9 FAX
2-53 91-6 2-3fo
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5I r#fr/3g e:9- I/ 2 /zo/4$ Pre 7o”css 06 L.L
NAME PRIMARY PHONE
See fa✓ .C.-4-
APPLICANT MAILING ADDRESS E-MAIL
0,,CITY "J:.,, '',y STATE ZIP FAX
NAME O/tir PRIMARY PHONE
PROJECT CONTACT J RQ�" ./'O� C/60 ;/i, F,'^e_ 2 3 2�g'26'5'9
(The individual to receive and MAILING ADDRESS FLMAIL r
respond to all correspondence t/06' S Atli /e C j oh" /2&I�'L1;IA7i iYes.�
concerning this application) CI'SX, STATE ZIP FAX
(4600"-.0) w4 `I'8it zJ 2_53 g zl Z 3 SG
NAME
PROJECT FINANCING 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 this application.
,/A �'/
SIGNATURE: 9 ' DATE
PRINT NAME: J////'h, Re.A1 L()fid t
Bulletin#100—January 1,2013 Page 1 of 3 k:AHandouts\Permit Application
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VALUE OF MECHANICAL WORK
a` 4
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/utaay) WATER HEATERS(Etectec)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
V C OImo.,/‘-elGS $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FI}C SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
RC1 Yes ❑ No cods E No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
3ANJ \/
FIRST FLOOR(or Mobile Home)
SECOND FLO yy;
COVERED ENTRY
GARAGE ❑ CARPORT ❑
', rfiprap yaT .... ............. ......_.._. ___. ....._........ _.___ __.....,
OTHER #idsveY'ib') ( rr \% !ry v\
6RISTINO PROPOS@D 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
r/NEw BUI NG'' r/ i / e ` f q ,/.4".•• \if
Stories
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet .e Stories
c //r
�OTIUILD, r %p/r/ \ \� Nr os ���cr r
TENANT AREA ONLY
+ rasp 1` \\ _ rp
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application