17-105484 ,,,,„_ _AIL PERMIT APPLICATION
CITY OF
Y PERMIT CENTER+ 33325 8th Avenue South + Fede W WA de980ralw03-6325
Federal Wa 253-835-2607 + FAX 253-835-2609 +permitces �J°ffeay.com
PERMIT NUMBER \ _ , S 4 s�- NOV 13 2017
�
TARGET DATE CITY OF FEDERAL WAY
M TE )UNI DEVELOPMENT
SITE ADDRESS S22 S 1'�j` (\�
PROJECT VA ATION� ZONING 2 -/ ASSESSOR'S TAX/PARCEL# A 6f
�„v ��� 2 2 3 zz7 _ 0 O S O
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING J.g‘FIRE PREVENTION
NAME OF PROJECT \\
PROJECT DESCRIPTION
Detailed Detailed description of work to 1 -P la 3 LAG, 'I YC S7s,-4. -7 'Tv 1 A ev`. ii
be included on this permit only
NAME '.i.k / / PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME ,-, PHONE
1- V'e,y/h cve, 72rO-72-? -)I‘fri
MAILING ADDRESS ( E-MAIL /
CONTRACTOR ) J er/g' /1( ,///0 ,rlt✓�JG: r'::- /'/Lf_SC,Li'YI.. N ,.4
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
T-'1, VI )t cf2 99. J-Ce 02/ '26' /2cj 1
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS S E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095) I I
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 Iaws.
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: ,,.../7 - DATE // ��'7 7
PRINT NAME: 7yn G'i'1 `f
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type offixture 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(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
I fir ,U? n,UM Tr,ORK
PLUMBING PERMIT OF. „rvvxn
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/Shower Combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
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?
❑ Yes ❑ No ❑Yes ❑ 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)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in I Construction #of
AREA DESCRIPTION Rnflare Feet p(Groups) Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
•
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application