09-104452 r • _ /D .f 52_
C,..aF
Federal vvagEIVED PERMIT SF MF CO ME EL PL DE EN(FP)
6D07. 1 3 2Q0CAPPLICATION
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,...,,=1 � � i� AWA y PROPERTY
SITE ADDRESS spy"�
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SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
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` i 'ROJECT
NAME OF PROJECT
(Tenant or Homeowner Name) eeP6Pm
❑ BUILDING ❑ PLUMBING El MECHANICAL
TYPE OF PERMIT V.
FIRE 111 ELECTRICAL CI ENGINEERING 4'FIRE PREVENTION j
I d (X)tl- t,' .441e, C (Zi4 l( -tYT�er- -}r) t1.C.L(7(YJ'mnriat
PROJECT DESCRIPTION Yle(,) til�j 1(l °i l 1Y2Iif;
Detailed description of work to ���YYY►►►111��� ��(1 ���LL3
be included on this permit only L%
_ PEOPLE may'
NAME PRIMARY PHONE
PROPERTY OWNER 916 ily/ �(}(�; / (15 ) 1 ZZ 7
- IL
MAILING ADD ,CITY, TATE, IP E-MAIL
OWNER IS ALSO: ❑ CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
\i(o4CONTRACTOR MAILIN(7 ADDRESS,CITY,STATE,ZIP -_ FAX
1/062 s`i AA' a reitoirlG t,4,44 % (953.cid..-„2 35Z)
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
)1 TH FS i 3tt C 'Y /._ / 31 /C'? 11-6 I-o000 56-oo-is i.--
NAME t- G, PRIMARY PHONE
APPLICANT �7'11� t` u( '1C_, (Z ) Z, 14J`
MAILING ADDRESS,CITY, TATE,ZIP FAX
ji CIL, 04.441 AVE 1: Tacum {, f (4`) Zi-1 (z5-.9) )9z1., -7O
PROJECT CONTACT NAME i, PRIMARY PHONE
(The individual to receive and Y Imo-) (Zc3 )6-1' , - ztm
respond to all correspondence MAILING ADDRESS.CITY,STATE,ZIP FAX
concerning this application) 1100 5-1-1-01 kr. E Tcramu,ICA q(9-1Z1-1 (Zvi)' 1Z6 -Z3 ci-o
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
1, Lurz
� . (15-3 Y1 Zia - l'fN V.innlr>ria111T rfll-t (-(-01
PROJECT FINANCING NAME N''
❑ OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(new 19.27.095/
( 1 _
I certify under penalty of perjury that I am the property owner or authorized agent of the property towner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
Ifurther agree to hold harmless the City of Federal Way as to any claim(including costs,expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a p/1arrt��of�,��this application. j I �s�1
SIGNATURE: '44?✓Y✓"w_ �✓x�t.wAn..I/�_ DATE i t f l 1 V-1
PRINT NAME: Y -ram)
Bulletin#100—4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
• •
MECHANICAL FIXTURES
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate number 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) TOILE"Ib 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
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ J&3D $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes ❑ No ❑Yes E No
RESIDENTIAL
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 PROPOSED TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
•
NEW BUILDING
ADDITION
COMMERCIAL —REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/21/2009 Page 2 of 4 k:\Handouts\Permit Application