14-105735 s
NOV 0 4 2014
cruorAPERMIT APPLICATION
Federal WaVITY OF FEDERAL WAY
CDS
PERMIT NUMBER T / - / 0 5 _2 & e .- E
J TARGET DATE
SITE ADDRESS SUITE/UNIT i
3S 1 C) 1 Cp-T rI Ave.. S.
-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL it
TYPE OF PERMIT [BUILDING D PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING $ FIRE PREVENTION
NAME OF PROJECT Pc- &
11,04 / L C -�r� ,,rr rr77�-
PROJECT DESCRIPTION If 4w. ��� 7 0 & "t)C i.1�1
Detnited description of work to /p�,Z.Z. i f�J `f� `2('
be included on this permit only vJ /)�11 e'r' �� . , -De-0A
NAME - t ,42.5-
PRIMARY PRONE
PROPERTY OWNER Ft etx.{'S loNvat./b e..V C,O 'T ZS-233-Cr I
MAIL ISO ADDRESS �` E-MAIL
_1 1 160 Mle\ S 1• 51L7;�¢ ' e 1
CITY STATE ZIP
P,elLtLvv� t.c.)a 98004
NA.. . /1/4Q{] C� r/- /1 PHONE
a 3 e)i' ✓1 't" t eN, �4 v C..0 L G- 3 --c-G, i-s goo
MAU,Dio ADDRESSjp E-MAIL
CONTRACTOR P-0' 2?t�r 222, �if'is ea..virtiekSerl tint.<owl
CITY STATE ZIP FAX
{�ao�;,..vliLe wA ct c 12 SC-0^217 -2,,S 45
WA STATE CONTRACTOR'S LICENSE• EXPIRATION DATE FEDERAL WAY SITSIIrEBs I/CEN/E•
(oo1 -ii4 44SC ' S / 3i /..20/5-
NAME
.2 /3'-
NAlSF. PRIMARY PHONE
SIA.veN-4. O.S CO,n�r.d - 3G 217-252''S
APPLICANT
MAILINO ADDRESS EMAIL
CITY 1 STATE : ZIPS FAX �_
NAME , PRIMARY P
PROJECT CONTACT T P( t ) �Ot,}!_Li �RI yS E-�t55
('The individual to receive and MAIL; ENG, �f� _ _ E-MAIL y,
respond to all correspondence �U'too "4�� �Jl'11eZ� r C�I./t iv. /,ZefJ J� -���1'.e bal 4-11)
concerning this applied Cion) Cir 2 1,� s STATE ZIP FAx w
•
SAME
PROJECT FINANCING OWNER-FIIQARCED
Required unh.n of$5,000 or mere MAILING ADDRESS,CITY,STATE,ZIP ONEC�
tRCW 19 27.090 -- -- y2.5-.ifc 3: / 57
I certify under penalty of perjury that I am the property owner or authorized agent of the property oumer.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 authorised 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 b any person,including the undersigned,and filed against the city,
but only where such claim arises out of the reliance of th including its officers and employees, upon the accuracy of the
information supplied tog ity as a . of thirapptfratio•
SIGNATURE: +.. I
I� DATE 1 / r 20X--
PRINT NAME: / 14t .i<, J L1W"
Bulletin#100—January 1,2013 Page 1 of 3 kaNandouts\Permit Application
• III
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
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 r m....
BOILERS FURNACES HOT WATER TANKS(au)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
-
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
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 Sink() TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS cavum gl WATER HEATERS(Fa.
HOSE HIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
L 0— -= 1...4a4
EXISTUCO/PREVIOUS USE LOT SIZE tIn Square Peet) EXISTENG FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
"7.2t5;
o& , 60 ❑Yes 0 No 'Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION tin square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
SMITING morons ror/u.
Area Totals
**NEW HOMES oi1TLXe*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL--NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction II of
in Square Feet P cy pl 1 e Stories Additional Information
NEW BUILDING
�� i ! A— Y A ,
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) construction of Additional Information
in Square Feeta Stories
TOTAL BuILDINo
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 kdl-landouts\Permit Application