11-101289 Il
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Federal A CITY of LOA' i T PERMIT SF MF CO ME EL PL DE E {AFP
COMMUNITY DEVELOPMENT SERVICES <:.�j �y ICATIO / ""' /
253-835-2607•FAX 253-835-2609 ,\ l i i\ : -
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SI ADDRESS
1 y r� %,)31 (03S
t,
i 10 35 l3 s
SUITE/UNIT# ZONING ASSESSOR'S TAX/PARCEL#
e7 U C, - 5
;a = ./4. \. Via. \ ,.'" O// �� h?
NAME OF PROJECT
(Tenant or Homeowner Name) \ t A O :c-c- "TT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING [Y FIRE PREVENTION
Add. 5')(w \cJC \r1C-C?"AS A(. r,-\t. cc:\\ ..s c'or.c( Sve e
PROJECT DESCRIPTION CGh� ��Q '4'a v.
Detailed description of work to S •
be included on this permit only
NAME PRIMARY PHONE - 3^
PROPERTY OWNER So -, j. "Txc„.,,—,A ( )
MAILING ADDRESS,ADDRESS,CITY,STATE,ZIP E-MAIL
316,45 a 3 A 5, �e ck c cA ' , wq C«o,_
OWNER IS ALSO: D CONTRACTOR ❑ APPLICANT ❑ PROJECT CONTACT
NAME PRIMARY PHONE
(?s3) :533 - i24fs
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
AC(c r�.\c�S. �.<-- N,SA. ,( C:Si.c.,t.QA (a5-3)93‘ - b/1 3
WA STATE CONTRACTOR'S LICENSE II EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
K05r31 17 � / it I/ -S/".60(,( l e,o_t3t
NAME
PRIMARY PHONE
APPLICANT T� v"n 'R'`Cicc ( ) 33 -
MAILING ADDRESS,CITY,STATE,ZIP FAX
)s3.3 -
PROJECT CONTACT NAME PRIMARY PHONE
(The individual to receive and C-a"ACQ.t.-tol" > A ( ) -
respond to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
❑ OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 1927.095)
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t the city as a, art of this application.
--
SIGNATURE: / DATE 4/'5"-".24)I )
PRINT NAME: YC-4..V •CIC K."
Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application
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,r ��R '�`� �. '�E 1141;,k �I �� t� ,f4Cyt,,,`ls* t '.fF,,L, �"
Value of Mechanical Work$ (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(Ga.)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
x *
PLUM.31 ,
Indicate number of each type of fixture to be installed or relocated as partof this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAYS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/umiryi WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES 1 ;TOTAL FIXTURES
GENERAL INFolusiATI
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ L1,0S1 $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes❑ No ❑Yes ❑ No
AWAa
' t ; r a >>i xl F
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT- !$$
FIRST FLOOR(or Mobile Home)
' COND FLOOR X1 2,
COVERED ENTRY
DECK t4 i� i l,� `� DHy€ ._ — --
E fiMIll .-,112N-?4.4.. ..,...4...,,,,'104,,,,..,
GARAGE D CARPORT ❑
OTHER(describe) y. 4, , • __.._..
EXISTING PROPOSED TOW. ..........•_......_.._................_......_.....___............._..__.._......_._........._...___.....__.
............
Area Totals
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL y� - NEW ifIINz k4, . . .
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
,1 '''',.-r!...',.,','..--. �-0,-,:''''''""'-'7-11N � k ' i
kink .,NEW BU 0 '',L_
€ � '3gE• \ / <y- ..YPW, ,� 3. �' t, , .. . fi .,, •
.
ADDITION
?- I1W O MERCIAI, _It .1A btA T JM PROV EMEE NTS W, It
AREA DESCRIPTION Area Construction #of
in Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL BUILDING.... cv R*. '.
TENANT AREA ONLY
q.� ':1
,
PROJECT',AREA ONLY `C 4 ! . W/ tom; A
Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Permit Application