09-102808 4 Federal PERMIT F CO ME EL PL DE EN -FP)
COMMUNITY DEVELOPM� CES 0E1\121°' / /
253-835-2607•FAX 253-835-2609 P P T�i/I(/�=V T I O i-N
www.cituoffecieralwau.com
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SITE ADDRESS
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SUITE/UNITY ZONING ASSESSOR'S TAX/PARCEL# r
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NAME or PROJECT _C `�ea, \ , C,f�( \\e. --- 1.ccs''
Tenant or Homeowner Name)
❑BUILDING 0 PLUMBING 0 MECHANICAL
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING Ci'IRE PREVENTION
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PROJECT DESCRIPTION
Detailed description of work to IT-
be included on this permit only
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NAM PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS,CITY,STATE,ZIP C „� Z2----7.?'
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OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 1 ' 0 PROJECT CONTACT
NAME PRIMARY PHONE
JO �" CONTRACTOR MAILINGADD ES CITY,STATE,ZIP ( ,-� AX vim
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WA STATE CONTRACTOR'S LICENSE# FEDERAL DATE EXPIRATION RAL WAY BUSINESS LICENSE#
i-- -1'('') EC IC147 k-'1 i-< '_l /?4 , c C)c 1_ i 0. i Y 1 _CIC; -
Uk- L\c:-rNsc_ -1;12-A PRIMARY PHONE 'e L
APPLICANT i•..\. , �. ( -3) L �C' _,
MAILING ADDRESS,CITY,STATE,ZIP 1 .
FAX
\"C '' 1.-( % A.j`1 .0^-" E- -CC 1 lit'S'�L: \ (?*+L) '( - 3 € i2-_.
CT NAME PRIMARY PHONE
(The individual to receive and ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
coyap (list{on) ( )
/ is ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
PROJECT FINANCING NAME
n OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) ( ) -
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to arty claim(including costs, expenses,and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information suppli to ie city as a part of is application.
SIGNATURE: DATE '2 - v
PRINT NAME: 11): p:,\„-\\ E \ �-(`( J�Q 1111
Bulletin#100—4/17/2009 Pagel 1 of 4 k:\Handouts\Permit Application
Value of Mechanical Work$ (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(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
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(Hand Sinks) TOILETS WATER PIPING
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
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 2.�(1)C
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No El Yes ❑ No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL.
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR COVERED ENTRY
DECK
— --..
GARAGE ❑ CARPORT ❑ — ---- —_—
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totais
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Construction #of
in Square Feet, Occupancy Group(s) Type Stories Additional Information
NEw BUI}rn!NG
ADDITION
COMMERCIAL-REMODEL/TENA NT IMPROVEMENTS
AREA DESCRIPTION Area — Occupancy Group(s) Construction # of Additional Information
in Square Feet _Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/17/2009 Page 2 of 4 k:\Handouts\Permit Application