17-105176 RECEIVED
�' 0C1 2 6 2017
CITY OF CITY OFFEDERALVAYERMIT APPLICATION
Federal ,, I„.y►TY DEVELOPMENT PERMIT CENTER+33325 8"Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+ permitcenter&ityoffederalway.corrl
PERMIT NUMBER 1 1 - I 5 f cQ - TARGET DATE P lig-
_SITE ADDRESS
SUITE/UNIT#
1142%4 s 32y-rA S r F6DERA1, Oki, 41A 9%0°3 151I5
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ L111030.00 1 5 0 05 O - O 0irD
TYPE OF PERMIT ❑BUILDING ❑PLUMBING 0 MECHANICAL ❑DEMOLITION ❑ENGINEERING )4 FIRE PREVENTION
NAME OF PROJECT FP
EAtEsor4 C-AiR PSACrtt — "Tt,JANT I14.1pRO,N/EME 4T
PROJECT DESCRIPTION k1sp1 Te ems-rtkei 1Sv1LD%NC nom ALARM -ro MELT Cote IN THIS
Detailed description of work to 3%1 t V e 031(5)
be included on this permit only
NAMEE `1 t-wr. PRIMARY PHONE
PROPERTY OWNER NARsc'v.► 1NYES'{M N F A t c1ES 2.53-ill-leIQ
MAILING ADDRESS E-MAIL
5c3 Pikcaftc kA V.11 S S-rr Z-- 140•T1lRy141-e1Ag .coM
CITY STATE ZIP
FI FE 'rIA %y2'J
NAMEPHONE
M^GFoac4 ELI:craw 253-223-1218
MAILING ADDRESS
Q p E-MAIL
CONTRACTOR PD oex 3(45 MAC(FisoLGE8 NOTMAIL.CCNU
CITY STATE ZIP FAX
Puygum> \M 1%1 I
WA STATE CONTRA C�},R'S LICEt i, sla�� I EXPIRATIONDATE) FEDERAL WAY BUSINESS LICENSE#
rft9
NAME A 4IJV`7E 1� ,//Q_ PRIMARY PHONE
�.M boRE CoWS`►Ru.riOn) 253-62V-scot"
APPLICANT MAILING ADDRESS E-MAIL
4109 ItotiTA Ave. E. dMooRbguiLtiegoF.eAMsQetMAIL.eoe
CITY STATE ZIP FAX
SuMNEit. WA "MO
NAME PRIMARY PHONE
p
PROJECT CONTACT -p1C14EL, Rii
otmr cne t 253- (o5-O!24
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 10 Box 30 MAveRcELtfl4VOLT a 4MAiL•CAM
concerning this application) CITY STATE ZIP FAX
pwAu-vp WA 98311
PROJECT FINANCING NAME 0
OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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. j,�/
SIGNATURE: 44 �J /����t r/� DATE /0" 24-/'7
PRINT NAME: �►c.P1EL gotm( liu t
Bulletin#100-January 29,2016 Page 1 (>1'2 k:AHandouts\Permit Application
I
VALUE OF MECHANICAL WORE
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 Ico,nr,ero,.0
- BOILERS FURNACES HOT WATER TANKS(°ay,
- 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.owerCanM) LAVS,,,„,s,,G) TOILETS WATER PIPING
- DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
_- DRINKING FOUNTAINS SINKS IEM1NONUISNI WATER HEATERS(como
- 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? ROPOSED FIRE SUPPRESSION SYSTEM?
Yes Ej No L_I Yes k 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 ❑
OTHER(describe)
Area Totals EXISTING PROPOSES TOTAL
**NEW HOMES ONLY*
ESTIMATED SELLING PRICE I #OF BEDROOMS
$
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of
Square Feet p Y p( ) Type Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY 3 27 Z R '
PROJECT AREA ONLY ,v