11-104711 , CITY OF,M n ;. VED OPERMI'T' MF CO ME PL DE P
COMMUNITY DEVELOPMENT Y ,! APPLICATION
253-835-2607•F •,, i; .1
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FEDERA � = ,c.t ;r.i/- it i 1 -c3n
sic=F
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL I
$ 00 -- - - - — — — -
❑ BUILDING 0 PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION 0 ENGINEERING )<`IRE PREVENTION
NAME OF PROJECT `'�''
(Tenant Name/Homeowner Last Name) �J M l�l4 ri za .1. ..4-11114., O'F i -1:1.
PROJECT DESCRIPTION -.i.0 c -r e. J 4 1 0 D FI - 6rg-i 4-1111-1—CZ-5 1-4:› 6044���.60,n
Detailed description of work to 1 Tho rot e.J W A4 I e-i ACP 1-4" /C)v°T
be incl flied on this permit only
-... NAME PRIMARY PHONE
PROPERTY OWNER 3Z.1 Z.3 1•14Z...71-1,) LL. - 'i Z,g ''15:5-- .36'69
MAILING ADDRESS E-MAIL
61 i is i=LU=J l.)C. L-11601/ -3
CITY STATE ZIP ,
_. _
NAME ..- PHONE
-rim vNA -rZ'--- R tom" FAir�-11 cv-i L1-c--- ''t Z5 3401-Z . 7
MAILING ADDRESS EMAIL
CONTRACTOR i CA W LOA c.•)i G IZO. S' t.Joiz r Ci RP-0.1 : ,Oa
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE I EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE I
'7
NAMEPHONE
..5 -E..sr1. P;airE t2OiEXt®1t1 1-1-- --: itL: 3t.07-2957
APPLICANT
MAILING ADDRESS E-MAIL
-at‘.)4tztT ri Ra�
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and st w� s+ T ` Z �� -Z.:(--15-
respond to all correspondence; G ADDRESS E-MAIL
this application) I.'�,5 i-:•1 k...;) i C... 1'7'-J`1 : Zireoj i F i r.4.1-6° 1 1i r'-..,' C -I/
CITY STATE ZIP FAX
614 0I.-iv-w113i-k i..1, di€Z z0
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
�- -- 41r OWNER-FINANCED
Required value of$5,000 or more t� ... 1 i"e^i1 L.A
(RCW 19.27.095) MAILING ADDRESS.CITY,STATE,ZIP
PHONE
193"z013 LAG 4i-tr,vlislit 4 98Lct0 iv-526 7 zci3 7
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' e..- .. DATE i
i i �.t t
PRINT NAME: S/4...Y1 f 't —4-Tr-a:W,--0-7 -.,..,
1
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
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MECHANICAL FIXTURES
VALUE OF MECHANIC-IL WORK $ 1 .::-` tJ (a copy of bid or estimate must be provided)
— e to be installed or relocated as part of this project Do not include existing fixtures to remain.
Indicate how many each type of f6ttitr GAS PIPE OUTLETS `. OTHER(Describe)
AIR HANDLING UNITS FANS r\1124
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial) _
BOILERS FURNACES HOT WATER TANKS(cas) > ,FIZJ r4�'�''..'Z>
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTINGGAS PIPING WOODSTOVES
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(orTub/Shower Combo) LAVS(Rana sinks)
TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALSOTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Elerrie)
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?
,des LI No ❑Yes o No
RESIDENTIAL - NEW OR ADDITION
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)
PatSrmc PROPOS® TOTALArea Totals
"NEW HOMES ONLY"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction
#of
in Square Feet Stories Additional Information
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Construction #of
in Square Feet pancy Groups) Type Stories Additional Information
TOTAL BUILDING ''� t
TENANT AREA ONLY �j`3,-,___,- - ,✓7 V
PROJECT AREA ONLY I
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application