10-101474 rN
m�F PERMIT cko'� SFWF Co
Federal Wad ME EL PL DE EN
COMMUNITY
52F85269ES APR 1 3APPLICATION S u r
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253-83607• AX SERVICES
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SITE ADDRESS
20/° Lam' . 0 - ..
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SUITE/UNIT# ZONING ASSSOR'S TAX/PARCEL# /1 '�- as.(' / O
Cfe 7 4— 2 . ,--e---0 -i_' o ,
................::::...........:
NAME OF PROJECT ,
(Tenant or Homeowner Name) �� / / J( , , ,,R
o BUILDING 0 PLUMBING [ 0 MECHANICAL.
TYPE OF PERMIT
❑ DEMOLITION 0 ELECTRICAL 0 ENGINEERINGFIRE PREVENTION
PROJECT DESCRIPTIONj, �� J
Detailed description of work to i ” r ve �-����� _,3/�)7
be included on this permit only
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NAME PRIMARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: CONTRACTOR 0 APPLICANT ❑ PROJECT CONTACT
�i PRIMARY PHONE
NAME � -
•-~ 1 +a 'F,0 SSS (s c)mL -j )
CONTRACTOR MAIL GAD CITY,STATE,ZZP J FAX
WA STATE•.• -•R'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
11 1' 9 `'G')`e` ' C.�1 d C' C.--4•-.l t'•':74.3 L"sl-t'-/..�
NAME +.. -- PRIMARY PH •`
� r
APPLICANT LI r ( ) -
MAILING ADDRESS,CITY,STATE,ZIP FAX
( )
PROJECT CONTACT NAME t /� PRIMARY PHONE �^
(The individual to receive and =)` 4 ui 0 G�� (-'-%x ) 6: '? '-Z3
respond to all correspondence MAILING ADDRESS,CITY,STA ZIP FAX
concerning this application) a 0 '13,, . -i4.,-;-7-3) iI,Ai'I 2-430C:2 /:..497,5-- '1
ALTERNATE CONT NAME: V WP°RI1 MARY PRO 7! E-MAIL /_//�
PROJECT FINANCING NAME 1
0 OWNER-FINAN D
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where suc. laim arises out of the reliance of the city, including its offic-rs and employees, upon the accuracy of the
information supplied •• city asap oft - ication.
SIGNATURE: /zz (/ DATE
PRINT N• . W d:,
Bulletin#100-January 1,2010 Page 1 of 4 k:\Handouts\Pemut Application
Value of Mechanical Work$ (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(cummercioi
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 sink.) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/utility) WATER HEATERS(medic)
HOSE BIBBS SUMPS WASHING MACHINES 'TOTAL FSS;
.........................
GENERALIIFQRI/ITIQN`
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
"2 , $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT;;
FIRST FLOOR(or Mobile Home)
• COVERED ENTRY
DEGIt
GARAGE 0 CARPORT 0
4 HER deser' 4
EMSTTSO PROPOSRD TOTAL
Area Totals
* W xonarls o � .
ESTIMATED SELLING PRICE$ _ #OF BEDROOMS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
:: ;NE4QHIIfiT*t3lNttc ;:. !:: z >:
ADDITION
AREA DESCRIPTION Area
Occupancy Groups) Construction #of Additional Information
in Square FeetType Stories
T4]T14L..BUILDING
TENANT AREA ONLY
t..0 OT ARER gNL1t
Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Permit Application