09-103956 ECEIVet • q 5-co
CITY OF
Federal Wa U 9 PERMIT SF MF CO ME EL PL DE ENCFP
c�cE 2009APPLICATION /
COMMUNITY DEVELOPMENT SERVICES
253-835-26�0r7,•ir{FAAX 253--883355-2609
wuw�ri1 111VF F :1 A 1
SITE ADDRESS
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
,
NAME OF PROJECT //� p J..� [�/� ,J
(Tenant or Homeowner Name) (21 0 ki Lund/�,l l (2CJo 1"1
❑ BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
El DEMOLITION 0 ELECTRICAL 0 ENGINEERING L x-IRE PREVENTION
3vsfetrg; (sRR)w,/1 / cd//'7 exas cr`.�
PROJECT DESCRIPTION sprit 1dcc sty sta n f L 1� m� . A e &of to/
Detailed description of work to
be included on this permit only � � u
PRIMAR
PROPERTY OWNER NQfGC �(L
! � /C.[ fij
(Lf7 ) PHONE
p
MAILING ADDRESS,CITY,STATE P E-MAIL
/02/6' tor*/z I % e Zamc." -/ WA .----
OWNER IS ALSO: ❑l�CONTRACTOR
ONTRACTOR — APPLICANT 0 PROJECT CONTACT
NAME YEstern- /y
p (2C?)(-7,)6 78M
MAILING ADDRESS,CITY,STATE.ZIP ✓ ,�^�}� �n ) ��n (� / FAX
CONTRACTOR /l )l0 1511 4 Ave
& GLt.L'O , Leif 1 02 ( ZSR) �x - 3v6
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
RIMARY PHONE
APPLICANT NAME V et C.514:1 CUL -roti rt...a. -
( Z 1�P ! U 6 tJ
MAILING ADDRESS,CITY,STATE,ZIP FAX f
/IO ) t )m _, (,UA ( D-3 r i96 . 2 3sO
PROJECT CONTACT NAME• PRIMARY PHONE x
(The individual to receive and I'I a ft ` +//ber4 (-2,..;-?)(436, -/��U
respond to all correspondence MAILING ADD�R%ESS,CITY,STATE, —� J , OP/PN.,/ FAX
concerning this application) //66 1/ f /( �t 1 .1 / (,b/1 7U!t T ( 2` ) o� - 3JO
4LTERNATE CONTACT NAME: PRIMARYPHONE E-MAIL
Lai p 1111/11,13 (,-,153)9ate, -/8(y.o L L.a. e nfl4 gyre-:am
PROJECT FINANCING N
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY•- - " PRIMARY PHONE
(RCW 19.27 095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim),which may be made by any person, including the undersigned, and filed against the
city,but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to he city as a part of this-• .
SIGNATURE: DATE
/
PRINT NAME: veru rn 6t.
Bulletin#100-4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
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Wit•. ....�a. �y.. ', ,�� ' ... ��.,,,, ,,i.i..'CUANICAL7VDETI.Jitts''''*'
�,
Value of Mechanical Work$ �`1 I.V� �- (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(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING 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) TOILElb WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINESTOTTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIR5.SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
(T‘ a Yes❑ No res ❑ No
C;., ��`\ ,:;', ' ;'': w,.�..'. ,�:''. '•.Ll
REswEN IA6,\'' �� ?�
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEINT
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
Dl(�
GARAGE 0 CARPORT 0
t7TH1yR,(cet'abn), , ti
EXISTING PROPOSED TOTAL
Area Totals
"NEW'HODIES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS N
AREA DESCRIPTIONArea Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
NEW$UILDINO
ADDITION
OM ..,,,.� EOI EL/TEN, I'r I P ) NTS
q ,.
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
Th LB11 r 1 I
TENANT AREA ONLY
YTt,J\ierAI1L`A OS,IL1"','
Bulletin#100—4/21/2009 Page 2 of 4 k:\}Iandouts\Permit Application