14-100167 0 - od
CITY OF
'ns, PERMIT SF MF co REI E
Federal Way �E EN m
COMMUNITY DEVELOPMENT SERV7CE8 APPLICATION JAN 13 2014
253-835-2607•FAX 253-835-2609
www.ciivorrederohuxu.corn
CITY OF FEDERAL WAY
SITE ADDRESS S�1J�,'DrNIT#
PROJECT 1q2$--a
S. ro/or On SZONING ASS SS /TAX/PARCEL#
$ X5(0 ID° 7 (7Z210 - 0 ° 10
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT \
(Tenant Name/Homeowner Last Name) ,/-,� }e\7 ) \,(6Z�\C>
PROJECT DESCRIPTION Wr -"- c ' r l n`Cl/�1-�r 1 .
Detailed description of work to `u(Q � ' 13r in kJer ) k -d
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
N PHONE
rO on F►re rvtec_-tior ?, )r�c z1'2:- 151.710109
MAILING ADDRESS E-MAIL
CONTRACTOR PQ 1 CX 1211 e�f,ic .�E.(To�, n�.corn
CITY STATE ZIP All
fl1 \\ CrR-€k. Wk °Sc)%2. 2z5-4 gl.%tdas
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CRow V3y4-tL 1 10 lc 19'gs- los6c 6,/' .
NAME
PHONE
F co,rne, a.c C()n1-7r C Y
APPLICANT MAILING ADDRESS
E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME
Jess1Ca— ROC1i7Scr) i 1 i /_r o
(The individual to receive and Z -"'1�1-7lUlU9
respond to all correspondence / AD sp�s EMAIL
concerning this application) �/ V X I�'I� ,Ps Ica ec OturiCP COm
pCI?'// (f-Pe/ Z�9?82.
14-2S.L -&(09
ALTERNATE CONTACT NAME: PHOONE L-MAIL
PROJECT FINANCING NAME
\c-5-1--A-e- Oo)\,r �o I � cr c ie cro n cvm
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.0951 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 a part of this application.
SIGNATURE: a-../.4( Alk✓_A..0%� DATE ,r) it)
PRINT NAME: ,X51 S/(L l 7t- )b>f"7cO
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
•
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $ _ (a copy of bid or estimate must be provided)
Indicate how many of each type offvcture 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(Gos)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how many of each type offtEture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Nana Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Eiecbic)
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?
AYes D No ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT 0 •
OTHER(describe)
EXISTING PROPOSED rornt,
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION •
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS •
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY •
PROJECT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application