17-105630 _4444,441/4„,„. PERMIT APPLICATION
CITY OF II^"V
PERMIT CENTER+ 33325 8th Avenue South + Fec) e6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@ic cityoffederaI�vay.com
17 / 0 5—i) c0 NOV z 2017
PERMIT NUMBER (�lni OF FEDERAL W
TARGET DATE COMMUNifiy DEVELOPMEAYNT
SITE ADDRESS SUITE/UNIT#
31515- P V V- l/Q j S
$ PROJECT VALUATION ZONING ASSESSOR',q TATRCE� ' Q
� ° (fiJ+l vll.
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING D MECHANICAL ❑ DEMOLITION ❑ ENGINEERING IRE PREVENTION
NAME OF PROJECT D j_ (((
PROJECT DESCRIPTION t-l\.
iDetailed description of work to kQ,u,
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNERD
NG ADDRESS E-MAIL
CITY STATE ZIP
•
NAM PHONE
fAr
MAILING ®SSOS ��,Q(^ E-MAIL
CONTRACTOR P (((������
CITY a` y S�� ZIP FAX
WA STATE RACTOR' LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME /'y A PRIMARY PHONE
APPLICANT- MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT 2,,,tq 01C3 -6,--77- 'MR
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 /1
PRINT NAME: L N C� _ j LL-
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
$
Indicate ho... to installed.«..,many of each type of fixture be or relocated as part of this project.Do not mceude existtngPxcures 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
VALUE OF PLUMBING W)R11 1
' PLUMBING PERMIT 1
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS or ub/shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING
T
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
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE ❑ CARPORT ❑
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EXISTING PROPOSED- TOTAL
Area Totals
ESTIMATED SELLING PRICE$ L#OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in Construction #of
AREA DESCRIPTION ( Occupancy Group(s) n,-,-...„- I StoriesI Additional Information
Smarr Fr et
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ADDITION L
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTIONOccupancy Group(s) Additional Information
S uare Feet �e Stones
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TENANT AREA ONLY
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Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application