10-102112 i0 — / Oc / / a--
,: - ..� . ERMIT
Federal Wa ' „i - o\I L-- CO ME PL DE EN FP
COM UNITY DEVELOPMENT SERVICES 0 APPLICATION
25:3-83S-2607•FAX 253-835-260SAA l\Y
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.{�j� �,1�,ERAL w Ati
SITE ADDRESa�
SUITE/UNIT#
--) 7(77 --.`W 9315:g k?7D' _‹-77–
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ - g 7 3 / FO _ 0 ? 0 0
TYPE OF PERMIT $,BUILDING ❑ PLUMBING CIMECHANICAL
0 DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) }_F &Lc..._
PROJECT DESCRIPTION �f L GY /, �— i '
Detailed description of work to �Q'(�f � �C
be included on this permit only J / a 5/�a f �/J VVV��. (Ta
NAME l ( PRIG PHOS ""v t
PROPERTY OWNER ' -`_'-:--;--,E-A/E. /4"e,e.A/2 .,_' �--...39-6 712
MAILING ADDRESSES, ,{ ^� y�� 7 y�
2 _,24// / /Q i i fEG t � ) 1! EMAIL
STATE ZW /9 s9
__s M4f�'E5 c,tJ 0, UP ,
NAME PHONE
MAILING ADDRESS E-MAIL •
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
_ / /
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE }'
(The individual to receive and — , /y/�2-
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more -¢_ i
(RCW 19.27.095) 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 supplif-to th tty as a part of this applicatio
SIGNATUR : _P..- -e, �`/ "e'- C/ DATE25
���Q�"��
RINT NAME: �GI E fi2 E PO 6.4,/L.E
Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Permit Application
i •
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not inciud sting fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commerci:
OILERS FURNACES HOT WATER NKS(Gas)•
C ESSORS GAS LOG SETS REFRIGER ION SYST •
DUCTING GAS PIPING WOODST' ES
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Indicate how many of each type of re 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) TOILET WATER PIPING
DISHWASHERS RAINWATER SYSTEMS •URINA S OTHER(Describe)
DRAINS SHOWERS VAC: M BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/utility( •TER HEATERS(Electric)
HOSE BIBBS SUMPS
WASHING MACHINES z'Ci!`1`l ?Yf 'CSES> ?
_ ." . . ................. .. :...... .
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......:.............................................................
CRITICAL AREAS ON PROPERTY? W R PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes❑ No ❑ Yes o No
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AREA DESCRIPTION(in square feet), EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE 0 CARPORT 0
Area t tats EXISTING PROPOSED TOT
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EST ATED SELLING PRICE$ # OF BEDROOMS
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Area Con truction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
.............................
In Square Feet pe Stories
ADDITION
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Area Construction #
AREA DESCRIPTION Occupancy Group(s) Type Storm Additional Information
in Square Feet
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TENANT AREA ONLY
Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application