11-102697 L 0 c'; �
Federal Way'`P\4°.
,,540P,„ ERMI ECFV I) CO ME PL DE E FP
COMMUNITY DEVELOPMENT SERVICES A P P L I C AT O N
253-835-2607•FAX 253-835-2609i �1 rl`.`i
ui_uy�.�.cih o eriemtu!gco._+r J 7 L L'r
SITE ADDRESS ci "'' FcE�ERAL WAY SUITE/UNIT#
Fj � / 1,4 ',X/ -he7ae bdel,
PROJECT VALUATION ZONING ASSESSOR'S TA /PARCEL#
$/'4, 79f,a' - - -
TYPE OF PERMIT
0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING kFIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)_ /vr31
_. '24)/ /J _ .,j ils C422_ ee l%� '
g /< c�.�lfY3lz 5/7747/1e , )-3- } /JV tY lJ c7T j®Aft)
PROJECT DESCRIPTION �l ,
Detailed description of work to a c e 1/111ee .j ieV".11 ed dJrp /J7/?i1,0 °'l//�1 /L'ei/'
be included on this permit only
77P
®® / _
NAME PRIMARY PHONE
PROPERTY OWNER 3.a»1S 6.14)k.17/ LZ-e- LA eer,. c),5 "_02 -y874)
MAILING ADDRESS E-MAIL
CITY STATE ZIP
-� 1--4.4)A4 __5:54230P-_ /
N
E /JODIE
MAILING ADD E-MAIL s�
CONTRACTOR !`1 I _c/i1,42)-77,-CX
e �fdi Salle %1912 6/444. m;;-Yi a ciJ.J� iwr
I&A
J G� I l9 rE 9
Ctf i
/:?5"1251- o9F7
WA STATE CONTRACTOR'S LI NSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
ep,v lie Z-feff e / / /0/C,? 0 _�1,0L0e--44-
NAME - - - PHONE
6'l A) Ji-i, ,41 - 3374
APPLICANT MAILING ADDRESS E-MAIL
54,ø ' Ate/ Co.)ll #ii/ . ` i
CITY
PROJECT CONTACT NAMEPHONE
(The individual to receive and iiilfee 43 O)/ Cyst)✓ _
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 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
information supplied to the city as a part, this a.plication.
lr
SIGNATURE: k >, ' ..1111rcrA(I_I DATE 11f5 - 7— /7
PRINT NAME: -A '- �A.A.J ---3-r174/
Bulletin#100-January I,2011 Page 1 of 3 k:\Handouts\Permit Application
• a
VALUE OFMECHAMCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offvcture 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
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 T , U
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE)Ia Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ No
.zr
r;
.,��t' � �._1;�.�..°,�..,"'.v.--M.°s,,..✓�:a:��;`5:�>�:" 't,. �:et ,;�s^�.,.. ,�:F��v, ,�<:�.,1,. ,ar. ..z.. <'�zrw�cn2,,� ? .�+s ��a:;'+s�fi+,;�,�.�,�z'.i
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
reti;d,v, ;744 106
fix,
GARAGE 0 CARPORT 0
a a
EXISTING TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
�, , ,, �s ,*^ � �F a � �s � .� � a s•n € a �&m �� 6,4
Area Construction #of
AREA DESCRIPTION in S uare Feet Occupancy Group(s) ,e Stories Additional Information
ADDITION
g r'f
z& r... 4 ! 4 ...a1arr P .a , 13 •
• •
Area Construction #of
AREA DESCRIPTION in S ware Feet Occupancy Group(s) e Stories Additional Information
krAtii
TENANT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application