09-104571 N
11/19/2009 19:46 FAX 541745 Barbara Wythes 2j001/004
114)
, CEI ,
0 2oe9 O - l �' S 4- I
Federal 2 PERMIT
SF MF CO ME EL PL DE EN FP
COMMUNITY OF;vE1A8)45M SE
Rre-DERALIVIIIILI CATION I / K-/&_/
253835271y'A]Ci252-35'26
tnwtu:ci7 tofred,•m'7u�ov,com ACS
3.
.k _ :dY . "nkO gl t k {
SITE ADDRESS
t,(i t' 1
WA—
SUITE/UNIT k ZONING ASSESSOR'S TAX/PARCEL
17.),G":1, 2- 0. - 2[04 r I -4 3 - v,
s,-' - 3thS: ixAb1 J i 9 z r y _2a . r , a
NAME OF PROJECT
(Tenant or Homeowner Name) —.— \C -7--,A, ,A( €�?1' JC.
4 .C) )y
TYPE OF PERMIT 0 BUILDING ❑ PLUMBING 0 MECHANICAL
0 DEMOLITION ❑ELECTRICAL L] ENGINEERING><YRE PREVENTION
PROJECT ki,A 'u} -tri,(f 111 '•�d.ca-t-. v,)L"`"!' 07' r r. �.,i
DESCRIPTION &+C P / :.t,'f a s." ,r.l -.
Detailed description of work to
Pi L�'I Pit, (r V t t
be included on this .mull on �( 1' \ r t
only G 'u ( C[t[(nn Th _`,c,(t_t 6i1Aifq+ 1 of via (�..CtS rdrret. ljt)if h,,,1
(ra.) -1--t, rte(o-ce 7 4i.,r�Ritskc/ r. 'i-r„c�
Xz>�E .il t-” -33Fy1 ''2.teog" g t,: +`�'3C - , td- ";yry�3�� :t x' o �z n =.a" 3 ' ,s st _rm _-yi
a
w..-,.x....•. , V ...I._�,n :' fry sr};�- t
e,.,w.
N PRIMARY PHONE._-
PROPERTY OWNER c(L V Y Q`/ pugL),c 4t racat_-r, ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAII,
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME 1 i
PRIMARY PHONE
- tOr-atik ) (' (\` n
trp Lnr.� 0'2-5) 2.1-1 (..,i, ( C-I`§
CONTRACTOR
MAILING ADORES CITY,STATE,ZIP Q{l�a5 �} /� FAX
7400C-V-4 CIr rAc. `U C . UUt) . Ufa..f((JJ (COU ) Y ((� ) --7
WA STATE CONTRACTOR'S LICENSE r / WAY LICENSE
, ,, I EXPIRATION DATE FEDERAL BUSINESS LICENSE#
f - - PRIMAY PHONE
APPLICANT NAME( w (.( t- OI1Gl P.,1 G' yA -.�—
MAILING ADDR�ss.CITY.ST
FAX
2 kle11/tr(Flc -L I e1.6v61$cb6 ti-26 ) 94 -5(024'
PROJECT CONTACT r E __.—_--
(Te individual to receive and at-ba.,rat.._. I PRIMARY PHONE
i
Li
(�C2�12'`T! �n !
respond to all correspondence MAILING ADDRESS.CITY, wT'E, t
concerning this application) I FAX
RA ALTERNATE CO ACT NAME: ''"
PR PHO _ �'j
PROJECT FINANCING 1)"t- t i r (2,0603q6- Q722, 0a fra..W rl tr i
dS prl�+�J[, ,
Required for projects with 0 OWNER-FINANCED (pmt
value of$5,000 or more MAILING ADDRESS.CITY.STATE.ZIP PRIMARY PHONE
RCM 19.27.0951
( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge,the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does
construction or environmental laws�t remove the owner's responsibility for compliance with local, state, or federal laws regulating
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person,including the undersigned,and filed against the
city,but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied tootthe
/city
/a�s�a�part of this application. //4(71 /f J
SIGNATURE: /< " `LLL (/L `�^ / " , ��t''c( 1 DATE /1—26 -/)
PRINT NAME: gall,' I e(/, �d?V"S(/ l' )
Bulletin#100-4121/2009 Page I of 4 kAliandouts\Permit Application
Barbara Wythes
}
• 11/19/2009 19:47 FAX 541745 0 002/004
r
v
ir:^•:xs':n:.:'i^c:.r.:.EiS^:ii%i::::::::::a';i il.:e:.adii=.:.�=x .osi:::::.::::..:::c: a-..,,.._.......,..„.,...-::.,,:...,.
Value of Mechanical Work$ _ (A COPY OF(311)9 &$T1 E MUST BE PROVIDED)
Indicate number of each type offixture to be installed or relocated as pajtofrth s project. Do not include existing fixtures to remain.
AIRHANDLING UNITS FANS _...--- GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE IFPS HOODS LCom rKrr d(
BOILERS FU .ES HOT WATER TANKS(call
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Indicate number of each type offlxture to'1;:e-in s'ial.led or relocated as part o . oJect. Do not include existing fixtures to remain.
BATHTUHS(mT,
rb/Showereombol LAVS(Hand Sink.) TOILETS WATER PIPING
DISHWASHERS RAINWATER SY URINALS OTHER(Describe)
DRAINS SHO VACUUM BREAKERS
DRINKING FOUNTAINS - ' isisii n/Uuury( WATER HEATERS(61.<:inc)
HOSE BIBBS - SUMPS WASHING MACHINES ::,..,TOTAf;FIRTTJREB:.`.`
' .'GENE •RA••L•INFO•RMATION.
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
851 6-n . $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
( e2-2 ACre 5 o Yes n No es n No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FO EPICS USE
.
FIRST FLOOR(or Mobile Home)
..SECO, D F'k04R..;? ,
..
COVERED ENTRY
GARAGE ❑ CARPORT D —_
OTHER{ ) -
Area Totals PROPOSED
ESTIMATED SELLING PRICE$ . / ��i� may#OFyyB��BEDROOMS
AREA DESCRIPTION Area Construct•ion #of
in Square Feet Occupancy Group(s) Additional Information
Type 11TEWBt719lbRla` Stories
•-B 2-
ADDITION � —
,.._ ... . . ...'''••••'•-•:•:
: • .., .. �P���Y��N� 2 'Ery s?^`i.r:ic�;
AREA DESCRIPTION Area• ..-:�:.,<: sn
Occupancy Gro Construction of
in Square Feetype Additional information
TOTAL BUZt bniti - .
Stories
TSNANT AREA ONLY
Bulletin#100-4/21/2009 Page 2 of 4 k:\I landouts\Permit Application