11-102322 CITY OF E R M I T Si' MF CO ME PL DE EN FP
Federal Way
COMMUNITY DEVELOPMENT SERVICES APPLICATION RECEIVE D
253-835-2607•FAX 253-835-2609
'UN132011
SITE ADDRESS SUITE/UNIT N
00
�0� >, 4-1 14 /4e' ) CITY OF FEDERAL WAY
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL M CDS
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT 1 /(Tenant Name/HomeownerLast Name) b-c---rTj
0PROJECT DESCRIPTION /�
Detailed description of work to °L 4 l A- {M v""( FA >/ -'m. 4^% - '‘-4.4.‘ LiuJL f.
be included on thispermit only 1
1 - .it` ,ir ► 14-1 -� Le.-4-14c-r.
NAME ?4,64„...., A �(/ PRIMARY PHONE
PROPERTY OWNER L II / ski Cogd°S -25 3, 'i`-6 -. 8131
MAILING ADDRESS `- YVV - E-MAIL
V6 S
CITY STATE ZIP
-Ld�r6. �, w + `ebb -3
N f PHONE
ft It h/ r . /�1'�- 266--13S-6(o
M ING ADDRESS E-MAIL
CONTRACTORo�`t j C 'L-/�Z � h S�T(rti� 4u-c�►t>:kh i��kt,-1, rh��/�
CITY STATE ZIP FAX ,6.0
fa*
A STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
W l,�_✓
NAME �`-'�Y�".� G�� / t•-•••-
/
is. __A‘,___i - / C , .)--' 3 -1- e .)-
' PHONE
{
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and '-- �1 r , J(-N )T 2.0(a - 3S
respond to all correspondence MAILING ADD ss / `E-MAIL /
concerning this application) C �D�(/ a�'c1-^tr'wln oN./ t,,, ,e�tfjfy'�
CITY STATE ZIP FAX
--ei 3$_Lj21--0
ALTERNATE CONTACT NAME- • PHONE `� E-MAIL
orl � - 2�t,-gas ro. To -I6c4trwMc-c-lrvN('L. ,,L
PROJECT FINANCING NAMEEl OWNER-FINANCED
Re �ired value of$5,000 or more '
cp �
IRC:W 19.27.095) MAILING ADDRESS,CITY,STATE ZIP PHONE
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 ••rt of this application.
SIGNATURE: n DATE � ` 3/ l
PRINT NAME: J�('c 0- i L !�f W,,1"�i
Bulletin#100—January 1,2011 S Page 1 of3 k:AHandouts\Permit Application
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VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fvcture 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
Indicate how many of each type of flxture to be installed or relocated as part of this project. Do no include existing fixtures to remain.
BATHTUBS(orrnb/shower combo) LAVS(Handsinksl TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM B• AKERS
DRINKING FOUNTAINS SINKS(Kitchen/Unity) WATER ATERS(EIrrtr c)
HOSE BIBBS SUMPS WASH "G MACHINES TOTAL FIXTURES
Q
CRITICAL AREAS ON PROPERTY? ':TER PURVEYOR SEWER PUR OR VALUE OF EXISTING IMPROVEMENTS
4
EXISTING/PREVIOUS USE LOT SIZE n Sgssare Feet) EXIST G FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑-Yes ❑ No LI Yes ❑ No
RES FII Q , 4 OR 1DT1t'i ICTTT
AREA DESCRIPTION (in square feet) IEXITIN PROPOSED TOTAL FOR OFFICE USE
fx4 -_9 ._--__...... _ _.. ...... _.....
FIRST FLOOR(or Mobile Home) �`
SECOND FLOOR
COVERED ENTRY
,7.� .�
.k,,..„...,1,;-<-:., -.7---::, .�. r, _,<. ,.... ..,'� ,.,1, .4 - ".., ., %, 3.,,:, .cx }
GARAGE ❑ CARPORT ❑
I
4,
OTHER(describe)
I
EXISTING PROPOSED TOTAL
Area Totals I
**.NEW HOMES ONLY**
ESTIMATED SELLING P CE$ 1 #OF BEDROOMS _ ,i
T
AREA DESCRI'• ION Area Occupancy Group(s) 1 Construction # of Additional Information
q Type Stories
in Square Feet
NEW BUILDING
AITION
I
v, .` rCONl..f (E Rl. ti.! '� 91'"Y � Ct1 NANT.1 '#_ i9O T lr �.7 ...
AREA DESCRIPTION Area Occupancy Group(s) Construction It of Additional Information
In Square Feet pe
TENANT AREA ONLY
A.N
Bulletin#I00—January 1,2011 Page 2 of 3 k:\Handouts\Perrnit Application