11-103346 CITY OF Ci ERMIT SF MF CO ME PL DE E FP
Federal
002 3-835-2609 FAOPMENT X 2 3 835-2609EA u G 1 7 P P LI CAT I O N
wu;w.cityotfederakuau.cmn
CITY OF FEDERAL WAY
SITE ADDRESS CDS SUITE/UNIT#
1900 S • 3H+" ST CT
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
(PC100 , `' o 0 Z I 0 y — 9 r 'L
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ ENGINEERING LeFIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) i1 C 1
F
Iz
PROJECT DESCRIPTION c C G X I J S d.'"T-1�/(, /�E JP8.-/ " i-® 1
'� /.
Detailed description of work to a )14 L.-tlI cE/C/,J(-y C/1 Yeti 7-" 14 OP #.-IC. (.) J/P C C.114 L L
be included on this permit only S.Z1/ak.(.0 12S TO 7-7 t: C.u QC PIT
NAME PRIMARY PHONE
PROPERTY OWNER W p LMAL Pr-opG 2T'(
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
(ilex ICS CAnAisTe crtOJ , lidG 253•S1t'1222
MAILING ADDRESS E-MAIL
CONTRACTOR 055 S. ?,O(i ‘1774C- T PDr t.(,AD O e piga,c4ca-ur-
CITY STATE ZIP FAX (Zrfc-rives C.Olh
i till (rq 99032 253' .i2°1211
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
glLcNc'= 21g01z LI / I / 13 "Zo•OC •!Oit/63 •ca'V,�
NAME PHONE
'PGTG2 PCU-1,10,) 25:3•' "12 �i222
APPLICANT MAILING ADDRESS E-MAIL
•7$55 S^ 20(0"z ITR-cc ivtLW4Doe44,iiLir-C°L.ktfrituLT/�M
CITY STATE ZIP FAX a C‘/8+
KMT ii lei gQ)03'2 253• ti` e `7271
PROJECT CONTACT NAME PHONE
(The individual to receive and V TC ®EL6y4 O O
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
t ICiL Vit.tYA(-O
PROJECT FINANCING NAME
0 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 part of this application.
SIGNATURE:� -- DATE ' ' 2.-01
PRINT NAME: PEr R- 'V C1-6.00 t
Bulletin#100—January 1,2011 Page 1 of 3 k:AHandouts\Permit Application
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VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture 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(cas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
7A4,`,‘,'W '',',''''., .r a
%iaii //rte f
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(orThb/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
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?
VYes ❑ No tr'Yes ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
!.,.. s
FIRST FLOOR(or Mobile Home)
$ ON'D FLOOR
COVERED ENTRY
GARAGE ❑ CARPORT ❑
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
.ig
AREA DESCRIPTION ''.'::i,'/.=1::.
mea ,•,,'O,.:-
a
,i-cPr,:<c-.,,:5u:1,<p:18.A,.ncy Groups) Construction-,>,,m- :-- .#,:;.f.of Additional Information:;:
in S•uare Feet •e Stories
ADDITION
--, /...,;;;:''1,1::::::::::';1°11,,...•__...--..........,,Amem..„ ::.,....:,-... .,...:f,:::--et,.r,-----9:;: -
,- ' '...'..,1,±*%:1''' ::-.:'''':::.''..If(14:::.'.1'2-1: ''
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in S uare Feet . .e Stories
TENANT AREA ONLY
PROJECT A c>1 Y
az
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application