11-104994 _ Q zt 9 cr4
Federal Way •PERMIT �� DE EN FP
COMMUNITY DEVELOPMENT SERVICES A P P L I C A T I O N
253-835-2607•FAX 253-835-2609
11, ritiloffvflemlwqysorn DEC 19 2011
AD jJ,/ F I
SITE ADDRESS yy
9-ncl F FLE.DtIU ,�lC
S Z j Z 5 Z %^ /N�. So LA-pi-pi �'D� - vs/A-1
�vs/A-1� , w9° DS 1 No:/Z-414
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# _
TYPE OF PERMIT ❑ BUILDING ElPLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING {YFIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) /414 01/144/t -ems, 73-
04G Dir tt Y rJ ` / 1-'�,AJ .,r / /4.),4.0
V` �N
PROJECT DESCRIPTION
Detailed description of work to 'Avv / s1 /1 t./6-0/E3n/T f/e'-Cf z r,
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
C Cn/Vl/L(,‘I n/' Ter(fNjL0Ca(c 5 'lei--C72 Z23-0
MAILING ADDRESS E-MAIL
CONTRACTOR 1/5'0 sit A-T rvt C-/C Ave S- lZIllCe.(y JWC� L CUA/14,--L6(✓r
CITY STATE ZIP FAX
ENI-CA/ ,Nit- t P.D5-3 z.5--z_s• -c>'YS'
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Gu'J✓,_'1L tr'?�`( J� / ( F
NAME PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
/41/k6 ?OWE") 4'0 767--7 7 YS
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) `6-0 .S/?,kT1-(ACK .,4V€ A/(lam; ifow�.+� Cvn/✓�if4( ,r C�,,�
CITY STATE ZIP FAX
; •e/V-r-o.") viA- (71e)'05 les---z.)—/- 0 9`f 7
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME OWNER-FINANCED
Required value of$5,000 or more
1441 L�e�'C nl Y2u
(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.
SIGNATURE: /41_
DATE /Z( /?l //
PRINT NAME: ,I« Pv J En/
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
0 •
� MEC IANJC_iL IXTU RES
,m
VALUE OF MECHANICAL WORK $ ,t, , +- (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to i 2 'Tv=: or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS F. ,l...1 M . , - GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
� ,„ r i aa ,'
�� b aid. .. - ,3.s;��i, ;., �q�:.. �.�„ ��z % ,� - »,.z r.,,.a:�,�s...�e�,exts,�,.�,.[: x.. �.ar .., ry�� ., ,.�.
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 TOTAL FIXTURES ,
r GENE A :,I, jpRMATIO �m,.-4
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 c No
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
I BASEMENT I- — --- —— —
iteriP.
ll
jFIRST FLOOR(or Moble Home)
SECOND FLOOR ,,,M i ,, y, ' �.
'
I COVERED ENTRY
DECK :.
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
,**ArEttriIOMES o ;
fix= ,� ,';: .. T7,t,'�c.',?^
ESTIMATED SELLING PRICE$ , #OF BEDROOMS
COMMERCIAL-NEW/ADDITION r
AREA DESCRIPTION
Area rea Occupancy Group(s) Construction # of Additional Information
in Square Feet Type , Stories
NEW BUILDING
ADDITION
COMMERCIAL -RE.4'IODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
In Square Feet Type Stories
TOTAL BUILDING ism
figNiTENANT AREA ONLY
,", r PROJAC'1 AFF k, 01IL1 r '
r
Bulletin#100-January 1,2011 Page 2 of 3 k:\Handouts\Permit Application