10-100955 IPERMIT SF MF CO ME EL PL DE EN LP
Federal Way .:01
COMMUN17'Y DEVELOPMENT Sled S IA PPLICATION •
253-835-26078 FAX 253- 'l . . ... . . .. ... ...:. . . i , .,
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SITE ADDRESS
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SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
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NAME OF PROJECT . r.
(Tenant or Homeowner Name) /qt.?'I'i (- ,17;/(1.7et' (:, 1 t(:,4" Cii /C111C (JA
0 BUILDING 0 PLUMBING 0 MECHANICAL.
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING F PREVENTION
/r7----t-4"' 64'/._
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAME PHONE
PROPERTY OWNER ()- 4 C c'es-y-e„- -(....e.,, ( )
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: 0 CONTRACTOR o APPLICANT 0 PROJECT CONTACT
- PRIMARY PHONE
NL, A
C-K)-ikike.e..?,.2.161(41.1.-6-?441,- t),C5)sS..' - 3(0 3 e
MAILING ADDRESS,CITY,ST1TE,ZIP & ,....., FAX
CONTRACTOR
A 7,?, 7 h4),/74.L?-6 1161-13,6v ( ) _
WA STATE CONTRACTOR'S LI EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE*
/ / - /
NAME /.c: . PRIMARY PHONE
APPLICANT .
. '
_...4 cz-ta, ( ) _
MAILING ADDRESS,CITY,STATE,ZIP i FAX
( ) -
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and - ( ) _
respond to all correspondence MAILING ADDFtESS,CITY,STATE,ZIP FAX
concerning this application)
( ) -
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( ) _
..........-
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.09S)
( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a -art of this application.
. ..
SIGNATURE: DATE ,
PRINT NAME:
Bulletin#100-January 1,2110 Page 1 of 4 k:\Handouts\Pennit Application
• 11111
Value of Mechanical Work$ (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(cotomermb)
BOILERS FURNACES HOT WATER TANKS(Gee)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
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(loud 5i ) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/ubuty) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTALFIXISTRES
:.........
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ j C
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes❑ No ❑ Yes ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
ASE dEIAT.
FIRST FLOOR(or Mobile Home)
• COVERED ENTRY
GARAGE 0 CARPORT ❑
... ..... .. saTao Pa sD TOTAL
Area Totals
ESTIMATED SELLING PRICE$ / #OF BEDROOMS
AREA DESCRIPTION Are Construction #of
Occupancy Group(s) Additional Information
in Squ a Feet Type Stories
ADDITION
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
'FOETAL $IIijL>fl G
TENANT AREA ONLY
Bulletin#100—January 1,2010 Page 2 of 4 k:\I-Iandouts\Pelmit Application