10-103215 $
ERMIT Ari17,; CO. PL DE EN FP
Federal Way
COMMUNITY DEVELOV‘E T APPLICATION i
253-835-2607*FAX 9
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SITE ADDRESS foect'kk" - SUITE/UNIT#
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PROJECT VALUATION ZONING ASSESSOR'S T PARCEL 0
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TYPE OF PERMIT BUILDING O PLUMBING MECHANICAL
El DEMOLITION El ENGINEERING CI FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) '^ •
•
PROJECT DESCRIPTION
Detailed description of work tokCr-1 itiw eiti) C-1/ k
be included on this permit only al') --J q4ae ris
NAME PRIMARY PRONE
PROPERTY OWNER 'N1 kloeir‘ ---- 2.6t--- g3 -3'131
MAILING ADDRESS E-MAIL
'3 3 tku e
CITY STATE ZIP
v1/4) 6-x w.A
NAME PHONE
-0"°:." 1-xce .-.
MAILING ADDRESS ,pvit E-MAIL •
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME -A- PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NA14: 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.
• •
1, (
SIGNATURE: ' DATE ( o
PRINT NAME:
Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Permit Application
-4111
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VALUE OF MECHANICAL WORK $ (a copy of bid or estimate m ; be provided)
Indicate how many of h type of fixture to be installed or relocated as part of this pro'- . Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS P ' OUTLETS ' OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS !•DS(Commercial).
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST •
DUCTING G PIPING WOODSTOVES •
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Indicate how many of each type of fixture to be instal ed or r located as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS a Sinks) TOILETS WATER PIPING
DISHWASHERS R ATER SYSTEMS URINALS OTHER(Describe)
DRAINS _ SHOWERS • VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WA HEATERS( icctric)
/ CHINES 'ii:?:':'C1`.Eit7i?R'•*.tV.ittBi::ii:i:fiii
HOSE BIBBS •, SUMPS WASHIN
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CRITICAL AREAS ON PROPERTY? WATER PURVEYOR p SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Squar/Fkeyj • STING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
t i ❑ 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 ENTRY
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GARAGE 0 CARPORT 0
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ I # OF BEDROOMS
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Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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ADDITION
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Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
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TENANT AREA ONLY
;:::::: .::::::::
Bulletin#100—April 14,2010 Page 2 of 3 k:\Handouts\Permit Application