11-100051 VD
j
urvoF W.,,` PERMIT SF MF CO ME PL DE EN FP
Federal 6 20��
COMMUNITY DEVELOPMENT 5-2609ES�P�0 A � CATION
253-835-2607•FAX 253-835-2609
www.c:tyol)edera)u aq.corn ep
SITE ADDRESS �� O�
CO SUITE/UNIT#
3.02 O 3).no/ Ave $) &h,'ld,n9 -C loo Ate
PROJECT VALUATION ZONING ASSESSORS TAX/PARCEL#
$ 7,/7? 1 -C y- C S - 0 0 3 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION E ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) C`A e,e- -I)"vesf,--,of lis ti,VY; L/e,decyi,- ,#'(6c.-s
Re1vc ,to 4"- .,,,i 4do( 2$ pe,1da.-,f 5Pcen,E--/,_,-_,
PROJECT DESCRIPTION
Detailed description of work to //)7..,, f)eel/ SPertd('t/ CC.l',5 Clr)G2i
be included on this permit only
NAME -- - PRIMARY PHONE
PROPERTY OWNER C/411.e. Qe+n✓€5711^',eett5 1.1.c.._
MAILING ADDRESS E-MAIL
32oZo 32n61 A✓ei -C/cv
CITYC L./4` STATE ZIP
rectr^ / 4.14 11.00 /
PHONE
a
NAME till I A F+ re S!S/e/�S 'Z.C+ 3 -?2,‘--i e OU
MAILING ADDRESS A b E-MAIL
CONTRACTOR 1/06' c* dot E joke) r 0S�,mr/rn.( ,,7
CITY STATE ZIP FAX
roc l0\ 1.\/14 ggif?J ZS3 9z6 233'0
WA STATE CONTRACTORS LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
SMT'7-1/F5l36oT /1 2. i/2 /9-57-aeM.13 -O0131-
NAME PHONE
S4r✓l.e_ a 5 Coil fly A.Gfv(-
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and 5o iv\ R�tk e r--(-0 ro4 Z S T-2`f8' 2659
respond to all correspondence MAILING ADDRESS_A� E-I1IAIL
concerning this application) n(" S V- A1,e- 6 .101„1 r 6)..9.,'71.4f'�e,cos.,
CITY STATE ZIP FAX
re,cod-r‘,.) L/, 11312614 253 926 Z35o
ALTERNATE CONTACT NAME: PHONE E-MAIL
t01t MMVAOS ZS) Zt1 ZbSS Laic 4 g S 17y,1C/Yo.Co ry
PROJECT FINANCING NAME
iv 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
PRINT NAME: i e o n Revi4 e r`ce.'-I
Bulletin#100-April 14,2010 Page 1 of 3 k:AHandouts\Permit Application
•
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture 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)
AI CONDITIONER FIREPLACE INSERTS HOODS(commercial)
RS FURNACES HOT WATER TANKS(Gas)
O PRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Thb/Showor Combo) LAVS(Hand Sinks) TOILEIb WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
NS SHOWERS VACUUM BREAKERS
NKING 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?
0 'A C4—
X Yes ❑ No ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRFL lr_Mobile Home)
SECOND FL//OO''R
COVERED ENTRY
DECK
GARAGE 0 CARPORT ❑
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
///��� in Square Feet Type Stories
NEW UIL INS---
ADDITION J
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area Occupancy Group(s) Constrution #of Additional Information
in Square Feet TypeStories
TOTAL BUILDING /2,04'S p-o..-Ce S V
TENANT AREA ONLY
ri
PROJECT AREA ONLY
y'�988 t
Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application