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ederaWaCEIVF%PERMIT •MF CO ME PL DE EN F1,. '
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�t °` FEDERAL WAY (SSV - U
CITY OF Eg Pi Cr i,7
19 SITE ADDRESS SUITE/UNIT#
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e •ROJECT VALUATIO ZONING ASSESSOR'S TAX/PARCE #
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TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING )FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) ( tie—, - 17.?-,c,E.% \'__
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME �I (�` i PRIMARY PHONE
PROPERTY
y � /_
PROPERTY OWNER re .k-(k,k MhC\ 1`\• lel. 4 C 1C / " 1 C/6
MAILING ADDRESS r ,,y r ,] E-MAIL
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Cld1 i cOLin
CITY ,j ` STATE Z
;ectk Y_c • ; te-- •
1 - CA- (l l n-.
NNAME ." ----- ..
4,� &CA6 L! ' PHONE
MAILING ADDRESS' 1 J NAIL
CONTRACTOR —i l�r�b C�j iV LI.} S{t lc ckCre� I�e`f'V y Q(` c ��``LCK'
c40,
61\/ STATE Z
PAX
'WA STATE NTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME
PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME, PHONE
(The individual to receive and �'� c (elf :q��--� e)-0C0
respond to all correspondence MAIL
-II1QG ADDRESS ► E-MAIL
concerning this application) L 0-b t Si. AUt,v S `)j (Slut k - 7e(eLriL, LC"'
%vrh w Z �ObI aS3- —E3V 0363
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 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 part of this application.
SIGNATURE: ���
DATE 7> 7
� / H
PRINT NAME: V I 61 4 �
Bulletin#100—April 14,2010 Page 1 of 3 k_AHandouts\Permit Application
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VALUE OF MECHANICAL WORK $ (a copy of Md or estimate must be provided) y��i 1 t
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to re 'n.• f
AiR HANDLING UNiTS FANS GAS PiPE OUTLETS OTHER(Describe) .,
V A
r.
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial) !
BOILERSFURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST . f
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DUCTING GAS PIPINGWOODSTOVES
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Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fvctures to remain.
LAVS TOILETS WATER PiPING
BATHTUBS(or Tub/shower combo) (Hand sink.)
DISHWASHERS RAINWATER SYST MS URINALS / OTHER(Describe)
DRAINS SHOWERS I VACUUM BR RS
DRINKING FOUNTAINS SINKS(Kitchen/Utiti WATER H TERS(metric)
HOSE BIBBS SUMPS WASHI MACHINES :' ? ``. + x'00'>' >'
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RPUR..
..................... VALUE OF EXISTING IMPROVE
MENTS
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR $$
EXISTING/PREVIOUS USE LOT SIZE(In Squar>s t) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
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COVERED
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COVERED ENTRY
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GARAGE
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...• EXiS1TN6 PROPOSED TOTAL
Area Totals
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Additional Information
AREA DESCRIPTION Area Occupancy Groups) StorConstruction #ofies
in Square Feet Type
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ADDITION
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Additional Information
AREA DE RIPTION Area Occupancy Group(s) Stories
in Square Feet Type
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TENANT AREA ONLY
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Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application