17-103988 ' RECEIVED
CITY OFA PERMIT APPLICATION
Federal Way AUG 17 2017
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER1 _ 1 ® 3ig ce _ F ? (`
TARGET DATE /
SITE ADDRESS SUITE/UNIT#
1'L UO tell: s_
PROJECTVALUATION ZONING ASSESSOR'S TAX/PARCEL#
?I 2,00 Z 5— 0 0 GI 0 - C) 0 5
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT NC400-ItTE 0.m4)-a RAcIN C.
PROJECT DESCRIPTION
Detailed description of work to Acca ct3) se!4.-04.S ac4 eX‘"S.kiA5 .sr,;��1-ef 51!}�!.��
be included on this permit only 1
NAME PRIMARY PHONE
PROPERTY OWNER Fi. WW--( (MA-WV-67 6.'6cc WE-VT �,.0,,,....000.........MAILING ADDRESS E-MAIL
fo300 AerioadiA fes) S' A * 2°
CITY STATE ZIP
A GAA) .#. Th LL$ CA 11301
NAME Patriot Fire Protection, Inc. P253-926-2290
MAILING ADDRESS 2707 70th Ave E E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
Tacoma WA 98424 253-922-6150
WA STATE CONTRACTOR'S LICENSE 41 4EAPI TIO I BUJ �L,DATi 6 FEDERAL19-91-101988-00-BL
9AY BUSINESS
PATRIFP099CF I '
NAME PRIMARY PHONE
A•v- Ccc.. ?5?--ties- y4
APPLICANT MAILING ADDRESS E-MAIL
Same as above .tc)' 4 Q r:ok.c ne ,ce ,.
CITY STATE ZIP FAX
NAME I PRIMARY PHONE
PROJECT CONTACT J(A-i, . C_c__A- z5;...yes--Y%'
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence Same as above 3atixct a rj ek-k v/e .('Qi".
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING f 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 th�• y as a parte"' is application.
SIGNATURE:,,..-/Or DATE a 114, 111-
PRINT NAME: �r\ CCi
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 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/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 n No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
r ASE ENT
FIRST FLOOR(or Mobile Home)
SECOND FL OR
COVERED ENTRY
GARAGE ❑ CARPORT ❑
OTHE.... .'escribe)
/y ......................................_.............................................................................................................................
Area Totals EXISTING PROPOSED TOTAI.
**NEW:HOMES ONLY**.
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
In Square FeetType Stories
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area rea Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDING i ? s.
rte..." ...,,.,t ..,:. ;��. - <.. „_.., ".... ..... :;.:.. •' `, .. ,�, . .,v, .' �... '"`.�.� ,. 'i7: :
TENANT AREA ONLY I t ll rR 'f 1
5
PROJECT AREA ONLY s
Bulletin#100—January 1,2013. Page 2 of 3 k:\Handouts\Permit Application