11-101957 i . - i �•- i; �r
Fed •PERMIT
gyp` /1'6-APPLICATION �MF CO ME PL DE E F�
COMMUMTYD SERVICES Ilv
253-835-2607•FAX 253-835-2609 . A P P L I C A T I O N
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SITE ADDRESSOF FEDERAL WA� SUITE/UNIT#
- ,:VVI C 3 5-,,,-47.-v- ,
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
\: C _
TYPE OF PERMIT 11BUILDING ElPLUMBING CIMECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT '/
(Tenant Name/Homeowner Last Name) ,•]. ;`
PROJECT DESCRIPTION .. r, //
Detailed description of work to .' ,y 4-A.- ll • a..� 1 of S s .2 p't. /tJ �t , !�
be included on this permit only a /'
',.e• ,A4.. _74 1' 11-0."-I ,.Q. /9--161,0,2 5/s'hir_
NAME PRIMARY PHONE
PROPERTY OWNER . . I,4^ .("35 ��,r�� `'
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MAILING ADDRESS E-MAIL
CITY ,,,�.,}} STATE ZIP
NAME % i�f..--`adri_- Pt', c<•6,,r i Pi', : PHONE
i %3WW' 4..I,,;y /N rc.. -, ,..52 11-cc-C'
MAILING ADDRESS ,�✓ E-MAIL
CONTRACTOR // VCair 6J ' /9 `- e _
STATE ZIP ^2FAX
7
WA/ ATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/Lfl L, ii f'<'-'-- .2- _i)/Lj / /
NAME , �^ PHONE
i'1-'' .SAY-f-FgZ41.er `'qP-30
APPLICANT MAILING ADDRESS E-MAIL
'‘77)"7- 6;10 /Skit_ £
CITE STATE ZIp,�, FAX
i./A1/�p 1 >>
PROJECT CONTACT NAME r� / y,,� �,( PHONE
(The individual to receive and -,'411 .1==' VnA. -i-t4:.\ F-'I.C'� Ley r ';s -(C39g '
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME 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
informatip• ed to the city • part'. this application.
ok i.'
SIGNATURIfia ► - DATE .-5//9/0e.)//
PRINT NAME: It ' .'_ /I il•. _ 4 1,_:
Bulletin#100-January 1,2011 Page 1 of 3 k:AHandouts\Permit Application
• •
NIECIIANICAL FIXTURES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many 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(comm.-riot)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
Mr:777177-777 ,`,44'
471P11.37Artrarfir"4,4:31
:417L: PLUMBING FIXTURES
Indicate how many 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 Tprt:Atkii(VE*47*1:4;1:1'
R,-;#0,-,,,,47,j< ,-k-4.;45f-4ZS;T.Fgr,*o,;;;,r,',';Zrf;pvtMyMAcffr.aTlt-*nfffVrtF,Vef45.VtrriWirjffFM;;E-VA::4-4s-lragrr
"“:-U104.1e -0-hiPatsg,
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?
Yes D No DYes 0 No
,„„RE__SEDENTIAL - NEW OR ADDITE0N_„;",Av",..fill;,,.:'g7:7";.;:Sitltnct.gfft,4tv.H'S-;-''''N:rti::.:'ff;S
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
tk40,44)-
- •-
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE El CARPORT I=1
041-1414,
- -
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
, COMNIERCIA-1,—NEW/ADDITION _
Area Construction # of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type , Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application