13-104999 RECEV• _ 04- Ct 6tC1
Fe Novo 7 2013 PERMIT FP
Federal Way SF MF CO ME EL PL DE E
COMMUNITY DEVELOPMENTS t l EPF FEQE APPLI CATION
253-835-2607•FAX 253-835-2609 CDS
www.cituoffederalwau.corn
SITE ADDRESS..:.
33'Fn/ ?111 ,1t'L sot tt
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
2 6 S / - 0 / '3 O
NAME OF PROJECT 7` r y� �
(Tenant or Homeowner Name) /JC Zie 1964/11 /
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FlIFIRE PREVENTION
PROJECT DESCRIPTION A°° R 2 X . i tAT • PO� TO A i
Detailed description of work to PN�L L S
be included on this permit only
.... _. ..... NAMEPRIMARY PHONE
PROPERTY OWNER 5N&5'I a31?PQA11 ( )MAILING ADDRESS,CITY,STATE,ZIP Tht•4M19 E-MAIL
/2v/ P . 4 xL 1/ qoZ_
OWNER IS ALSO: ❑ CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
SPR/k P'/Zt PRO'r' C:7-16&/ (ZSS ) 853 - 77/30
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
Z?D 9 3,R/Jt/ /°✓E— Nw (ZS3 )85? -S59D
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
5PRr,s./ PO//G a /2 /3/ /i3
NAME PRIMARY PHONE
APPLICANT 6, o ' GAJ (G 53 ) &,T - 77841
MAILING ADDRESS,CITY,STATE,ZIP FAX
2.0 74/19A) Avg ,vim -,z& (Z" )S53 - SS`fid
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and 44, 6J 91"' '' (% ) 1,24? - /76W.
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP
FAX
concerning this application) 2 . ANN P tiki .?/7/7:-
(�.s.�) s3 - SP9o
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( ) ',ZYC.5--Pei /x F I .CoA1
PROJECT FINANCING NAME
0
OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.0951
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
'further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim),which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the ity as a part of this application.
SIGNATURE: DATE ///6�3
PRINT NAME: ,: 4e 9 �,<.,1 ��
Bulletin#100—4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
• •
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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 SEIS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate number of each type offixture 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) TOILE IS 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 s44TOTAL FIR UM„ ;
4,t x GENE . ' 14NF , ATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ ZL/86 $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FII,SPRINELER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
ir1C+ IF/Yes❑ No ❑Yes ❑ No
G5PAREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT1',e,,-'
FIRST FLOOR(or Mobile Home)
SECOND FLQO , ` "`
COVERED ENTRY
................................................................................................................................................................................................
D e
GARAGE ❑ CARPORT ❑
OTHER(describe) tigigiiti7N, —7`
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
AREA DESCRIPTION Area Construction #of
in uare Feet Occupancy Group(s) �,- Stories Additional Information
ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) • Stories Additional Information
• IIII DING *
TENANT AREA ONLY �.
r PROJECT AREA ONLY '1'1";:;;;"'`
Bulletin#100—4/21/2009 Page 2 of 4 k:\Handouts\Permit Application