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Federal Way3EC 3p 2t
, PERMIT
SF MF CO ME EL PL DE EN
COMMUNITY DEVELOPMENT SERVICES
0
3332FEDERAAVENUE SOUTH -� .. PPLI CATION TD
FEDERAL WAY,WA 98063-9718 - /
253-835-2607•FAX 253-835-2669 �+
www.cituofFederalwau.com CDS
The following is required information-an incomplete application will not be accepted. Please print legibly(in ink)or type. VIS)
• PROPERTY INFORMATION
SITE ADDRESS S L 1 Z S 3 Z n d Ave- Gj Fe dercl iyy C) SUITE/UNIT# 1 0
ASSESSOR'S TAX/PARCEL# 2 I 5 4 5V
6
- 0 J 0 LOT SIZE(sf)
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) to-is DA r- as S1►LLft Ca 1 Ae. alsi U r►IpvS CC((.A(cLie pc,r(,K pa/cr"(
V V� i 1Cl fi 0 r
''''""'''As (tctrded Under Kin Cr;vl'� y i40o(3 i7
• PROJECT INFORMATION
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING LefIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit on/u)
AcicIAA, and re,locl;4)n. e.xis+lnj 5piInKier heads rfooi ail ex(s+1nc, tee+
rsp iAele;r sys Vic->11.
PROJECT NAME(Name of Business or Owner Last Name) 1766,414/ 4 L COC L/44S
MI PEOPLE INFORMATION
PROPERTY NAMEPRIMARY PHONE
OWNER gt.)/.3 /v it. don/44e-J (42. ) 2 E,c%- 4SL)U
MAILING ADDRESS CITY,STATE,ZIP E-MAIL ADDRESS
6/4 /L//c Viii /day .5i: gL Ur yve w,4 / z4 br,wrderic:lei 3i.e ccIn[.0 s4,/r4-
CONTRACTOR COMPANY NAME APPLICANTNAME OFFICE PHONE
Advai►ced Are PAj-/edict, x-thew) kii.b^c" (4 3) 48.3 -565/
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
/C- D/C 4543 Wccd,nv,')lc VA 9K 1L (206 ) 730 -6G4L
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
II - El-000OO7—CO- GL r2.- 31— I0 ( ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
/9J>1//-ln FpJ(/9676- 05-Q/ -/i J.r),'I,',4.,6ud✓F%e i2eL
APPLICANT COMPANY NAME APPLIC NAME OFFICE PHONE
Ad v'i- ed �✓c /''i;,�71tc lr�r, Ja,14 i1hCA Mn;`),'�i (4-i s) 433 -.j6,7
CELLCITY,STATE,ZIP PHONE
MAILING ADDRESS Y a 0( /543 ' /�o Cl r vl I)r WA 9Kg1 L ) -
RELATIONSHIP TO PROJECT W /4414
,t FAX NUMBER
❑ Architect D Tenant ❑Agent i Et /0l
her 9ec'1 44 c,t'r ( ) -
PROJECT NAME (..)q [ ��/ PRIMARY PHONE E-MAIL ADDRESS
CONTACT /1,Tti)t/) /-1, 6,-6,1 (4 5 ) 46-3 -:Sa / .h),./;: eic,,tvi;'t a.lN_4-
LENDER NAME Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITY,STATE,ZIP PHONE
( ) -
■ DETAILED BUILDING INFORMATION
EXISTING USE IA11 X ed PROPOSED USE /4 i x C d
EXISTING ASSESSED/APPRAISED -VALUE$ VALUE OF PROPOSED WORK $ / 0/G)
SPRINKLERED BUILDING? 10l/ES 0 NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES 0 NO
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
Federa *PERMIT •MF CO ME PL DE EN FP
COAIIV N1TY DEVELOPMENT SERVICES APPLICATION
253-83.5-2607•FAX 253-835-2609
ruaa::5P IaJHh);ro:;.cc r;
SITE ADDRESS SUITE/UNIT 6
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$
TYPE OF PERMIT CIBUILDING ❑ PLUMBING CIMECHANICAL
❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
PROJECT DESCRIPTION
Detailed description of work to
\e,be included on this permit only ,x\ _
-
NAME PRIMARY PHONE
V
PROPERTY OWNER �%
,,,A .
MAILING ADDRESS E-MAIL
CITY Z :J SICATL 4l Z,y....-
NAME I " PHONE
(11
MAILING ADDRESS E-MAIL
CONTRACTOR \
CITY STATE ZIP FAX
WA STATE CONTRACTOIj'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application)//
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
El OWNER-FINANCED
Required value of$5 000 oe 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 arty 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 apart of this application.
SIGNATURE: :)014(1 414✓j A i, • , DATE
PRINT NAME: 1'. .14 1'-1//-)I✓ Al it//i ri/
Bulletin#100-April 14,2010 Page 1 of 3 k:AHandouts\Permit Applicatio
,
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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(commercial).
BOILERS FURNACES HOT WATER TANKS(cm)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST •
DUCTING GAS PIPING WOODSTOVES
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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
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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❑ No ❑ Yes ❑ No
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AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
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FIRST FLOOR (or Mobile Home)
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GARAGE 0 CARPORT 0
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EXISTING PROPOSED TOTAL
Area Totals
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ESTIMATED SELLING PRICE$ # OF BEDROOMS
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Area Construction #of
AREA DESCRIPTION Occupancy Grou s Additional Information
in Square Feet Type Stories
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ADDITION
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In Square Feet Occupancy Group(s) Construction #of
Type Stories
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Additional Information
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'letin#100—April 14,2010 Page 2 of 3 k:\Handouts\Pelmit Application