09-104421 vo
`e �� PERMIT iii-- -
F CO ME EL PL DE EN , FP
Federal Way=,GE -
COMMUNITY DEVELOPMENT SERVICES .�ti 1nA P P L I C A T I O N /
253-835-2607•FAX 253-835-2609
www.dhto((ederd Eau.corn
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a �p '"aj� e, ,RFs ,',
a1TZ ADD:ins (J
3(45-0 E \ -q US .A .
SUITE/UNIT 0 ZONING TAX/P
Na)D1trAG b ow . .lWN+ms�e,‘cAt. 78 a s -
00 / 0
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NAME OF PROJECT (� �1
(Tenant or Homeowner Name) g[`, RRA k)C S 'DJ,-.,-,--,-
(Tenant ,A .
0 BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING �I FIRE PREVENTION
IA L- -S 0 0 ,N",)ud.c 1- 102 4 v - i c k& S ikKi.RES i W
PROJECT DESCRIPTION j Jl.
Detailed description of work to
be included on this permit only
l , 1 ,Stsa
NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
tJ(-(i)1lvV 1-1264 a -fy►i.Yi.rte ((vac , ( ) -
MAILIN DRESS,CITY,STA ZIP FAX
CONTRACTOR Pt) ( 7 itk 1Z11IM '.iw�Vv A 4 L- - 3 j ( )
WA STATE CONTRACTOR'S LICENSE# zaanitanqN DATE FEDERAL WAY BUSINESS LICENSE S
A1P ►NS0 -/-1Ke (t ) / ;�,.
NA c111 PRIMARY PHONE
APPLICANT � ---c6 r2' .N')5 ( ) –
MAILING ADDRESS,CITY,STATE,� ZIP/���(� I —I FAX
S.6 t V v U S 4 i-6 i47-- ( lib) •
-S/
PROJECT CONTACT QN��n rilli2:10
r
(The individual to receive and U[1 r N/1].) (3().6) 7 S j- 4 Li
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) (3/ ,l ) ?S J - 5b,t s/
ALTERNATE CONTACT NAME: PRIMARY PHONE � E-MAIL /�� J
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with --- --_
value of$5,000 or more MAILING ADDRESS ZIP_—_.._ PRIMARY PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation a,• defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only wher suc `claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information suppli.d to city •. a p of this plication.
SIGNATURE: DATEt (
(, r
PRINT NAME: >r-<J G �4("hil)\,/n c
Bulletin#100-4/17/2009 Page 1 of 4 k:\Handouts\Permit Application
Value of Mechanical Work$ (A copy OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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(commertial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING i WOODSTOVES
• ,...
Indicate number 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/Utility) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FICTQ1rE.S
GENERAL INFORMATION
WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
(.\\:,,,,:iwPROJECTroppaweesilsrVALUATION
LOT SIZE S uare EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
(In4 Feet)
❑Yes❑ No ❑Yes 0 No
BESIDE' ,
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT -- —
FIRST FLOOR(or Mobile Home)
SECOND,FLOOR
COVERIJH,ENTRY —
DECK
GARAGE D CARPORT ❑� —�
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
*kNEWH llYli'S lJ.7 r* r:
ESTIMATED SELLING PRICE$ #OF BEDROOMS
(, 'MERCIA . —NEW/ADI}ITI(}N
8
AREA DESCRIPTION Area Construction #of
in S uare Feet Occupancy Gro [s) Type Stories Additional Information
YMt1ti � '
ADDITION
Q
1 ,1 ¢ L/'1`ENANT ®ROSE m�
AREA DESCRJPTION Area Construct' . #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application