12-101675 arr OF qM, PERMITEvcipo MF CO ME PL DE EN eiED
Federal Way
A P P L I C A T ITeIV
COMMUNITY DEVELOPMENT SERVICES //\/
253-835-2607•FAX 253-835-2609
of_u.�r eitR prlf2sI gitsfir.+ PA'R 16
2012
c DFRP�WP\I
SITE ADDRESS -�QF`� SUITE/UNIT#
�� 1D S1 A-VC `I 7gooi 1 y o
PROJECTJVALUATIONS y ZONING ASSESSOR'S° TAX/PARCEL# //- lC�J /1
$ 5'/_ /� a K"'- /� s9C l (4 C p cJ- - V 0 S V
TYPE OF PERMIT Cl BUILDING 0 PLUMBING` ❑ MECHANICAL
Cl DEMOLITION 0 ENGINEERING lc FIRE PREVENTION
NAME OF PROJECT A
eAr/�'_/((Tenant Name/Homeowner Last Name) CJ
PROJECT DESCRIPTION _
--°WT vE APR)UReg -'t E+ kmlile, 1-.Jc '7b u/aUi4OL-`
Detailed description of work to .
_r_
Detailed I LIF-e- s-4 PL tt y f)E l/)t-6.--S,
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER TD Db _A-T--rcJ o 9�) --S 7 )-
7 -no
MAILING(ADDRESS E-MAIL
04i15 -7anc.( AVE S ' Sul-1E- '1(b -t odd, 014f-t on ..,cbrt:e(--,0N.
CITY STATE ZIP
K£NT LVA q 6 03 9.
NAME �DE.--12K PHONE£a/)V -6-IN -r TE-(Ji A1O 1‘,00-/E l C z11) / 3,,3•- 7eke - G��6
1
MAILING ADDRESS
/i .E-MAIL rJ�vP f�i�,�`cz:'
CONTRACTOR / 5o S1f' T Zf( AVES UIerE�C.o i tv✓i1
CITY STATE ZIP FAX
/ZZ,/(/Taw w4- 9i'5'7 "30-w5-teea9. 8 -csr-61.
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#L:
CO N VI (-L 9811A0 Si / Iii /90
NAME (,I'c r-r2 d'1 Jaz:e) PHONE "- - _ ---- -
( /f ,' M)Ll,�'n 1,0 c- lid -776 -S82
APPLICANT MAILING ADDRESS E-MAIL f-te,o rim i f i z✓'to`,is a�
iLi& ',)rc( Al/E7 5
CITY STATE ZIP FAX
�D 01V D_; CU. s Do
PROJECT CONTACT ',NAME PHONE
(The individual to receive and � P"E K 01,60A1 /- d
n 5 -766 -S ,i6(
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) ( 1a, SW/177-(>Cu ,1 tJ '- cies' K-O i-60 41 e-erI/Vc(1 4-.11..ce
CITY STATE ZIP FAX
127_71/Tem/ kiA- `f 3 c,, JI
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCINGS NAME ,,,,,_ 0 OWNER-FINANCED
Required value of$5,000 more rte
(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. /�l6/� , /
SIGNATURE: '' DATE �(�! 01-
PRINT NAME: /G.k0, y1 //1 4'illei'S
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
•
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(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
' :•tom - x ,. '. .; •�', rk�,+.. °" i v' ,-«;5+ '
Indicate how many of each type of re 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
IWitx a• z ,- F'o
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
'f r i ,ar✓.+,.
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL !Pry FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑ --— ---
EXISTING PROPOSED
Area Totals
mkw J
ESTIMATED SELLING PRICE$ # OF BEDROOMS
IffriVal
fir..•
Construction #of
AREA DESCRIPTION Occupancy Group(s)
.e Stories Additional Information
, 464504
a 9 t ria.
ADDITION
AREA DESCRIPTION Occupancy Group(s) Construction #of Additional Information
a Stor'.-s
r. z F -:/<' ^t "A' -4-44w40#„ �. �i r *�1441 d �
1-0 bee �,;,y r � $na.
riwy' . ' ,: -.ma _Yyins �'✓ .
TENANT AREA ONLY
Bulletin#100–January 1,2011 Page 2 of 3 k:\Handouts\Permit Application