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O` PERMIT S4 ME EL PL DE EN FP
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(Tenant or Homeowner Name) L- O m
TYPE OF PERMIT Z BUILDING iEr PLUMBING 0 MECHANICAL.
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING 0 FIRE PREVENTION
,fix -1�r e ski 61-0 k 4r 1,G.,,• �� 4/
PROJECT DESCRIPTION ,�/ /� `��
Detailed destrrption of work to /t G�`� -.5- G �`-/'o�y ,yvXf G i� 4E..
.Aft included on this permit only /�1 9i s /,:),‘,/ ,�/GG / . / s /�
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NAME ' F:.
PRIMARY PHONE
PROPERTY OWNER �c�_�4.G•7Gr-C 7�'�/ SeVe/•f�/' ,S /fl/�JDA,s .(2j )9 -‘/.5`‘
0 ADD CITY,STATE,ZIP E-MAIL
/ :2 ' —,g 5/0m/72o1-7s
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
N �T PRIMARY PHONE
CJ �"74;44..5�,--;;,,,,4„,4,--, 1G/1 L ) -
CONTRACTOR MAILING ADDRESS,CITY,STATE,r, 7/o°v2/ FAX
WA STATE CONTRACTOR'S LICENSE/ EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5l/ o g•14 q//kT 2 //1 /2o(/
NAME
/��., 1/ // PRIMARY PHONE
APPLICANT 5.$/!/l C'_ Q S c',2N,'L4 /' ( ) -
MAILING ADDRESS,CITY,STATE,ZIP
FAX
PROJECT CONTACT NAME )
PRIMARY PHONE
(The individual to receive and yr �-.47,,,_.‘ / ( ) -
S
respond to all correspondence MAILING ADDREgS CITY,STATE,ZIP FAX
concerning this application) 23,(,2 fA/6X°1 Si: 144 42 W4 578e'Z/ ( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
VeC )6/ -/25'7
PROJECT FINANCING NAME /1 .
Requiredfor �.y d 1- Z7 .2 - OWNER-FINANCED
projects with 7 sit /7Z/Y�o�/!s
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
MCW 1927.095)
£"3 )03 9-g/f
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best
of my knowledge, the information submitted in
all applicable City of Federal Waysupport of this permit application is true and correct.I certify that I will comply with
regulations pertaining to the work authorised by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such cl arise out of h- reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t ty as art , - "application.
SIGNATURE: l I DATE 2/-/o
PRINT NAME: e CVC ,r u Q`/
Bulletin#100-January 1,2010 Page 1 of 4 k:\Haudouts\Permit Application
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of Mechaniork$ • (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
I> licate numb ach type ofjbtture to be installed or r:lo.:.ed,J part of this project. Do not include existing fixtures to remain.
FANS /` / OTHER(Describe)HANDLING UNITS. GAS PIPE OUTLETS ( )
AIR CONDITIONER FIREPLAC .' RT. HOODS)commerci4
BOILERSFURNACE• HOT WATER TANKS(Gee)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTINGGAS PIPING WOODSTOVES
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Indicate number of each type of fixture to be installed or relocated as part of this project Do not include existing fixtures to remain.
LAVS(Head Sinks) 3 TOILETS WATER PIPING
BATHTUBS(or Tub/Shower Combo) ) URINALS OTHER(Describe)
DISHWASHERS RAINWATER SYSTEMS
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS Z SINKS(gn.b.n/utility) WATER HEATERS(Heck
HOSE BIBBS SUMPS
WASHING MACHINES 'm�PAL TrIXFURES
R
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PROJECT VALUATION WATERPURVEYOR ... SEWER PURVEYOR /� VALUE OFEXISTING IMPROVEMENTS _
$ /72 6°n . G /�lvL/6..6, /V UtC� ./ ' J//J�_"�' Zt./ " 17 ROPGSED FIRE SIIP RESSION SYSTE1l7
WSIZEEMSTRGSPRINKLERSYSTE
EXISTING/PREVIOUS USE LOT (InSquare Feet)
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q es 0 No C��( i .r ik
L Cl
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE'USE
FIRST FLOOR(or Mobile Home)
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• COVERED ENTRY __
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GARAGE-❑ CARPORT 0
4 THEi (descrtlie# -
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EXISTD76 PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
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AREA DESCRIPTION AreaConstruction #of Additional Information
q
Occupancy Group(a) Stories
in Square Feet Type
NH:.A$I[t4E1GFG
ADDITION
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AREA DESCRIPTION • Areat Construction - #of
OccupancyAdditional Information
in Square Feet Groups) Type Stories
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TENANT AREA ONLY
-, PR AREA ONLY,
1
Bulletin#100-January 1,2010 Page 2 of 4 k:\Handouts\PetmitApplication