18-100850 .
CITY OF PERMIT APPLICATION
Federal Way PERMIT CENTER+33325 8th Avenue gig
i��r W 38®3-6325
253-835-2607+FAX 253-835-2609+ e InI cen a citvof e eralway.com
�J(�� FEB 2 3 2018
S Pi CITY OF FEDERAL WAY
PERMIT NUMBER ( - ( O 0 5 0 _
TARGET DATE N 'flU Y DEVELOPMENT
SITE ADDRESS SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1 el -) . 1 mat 9 - 0O S0
42 ' C D NvvVi✓L • —
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING N.VFIRE PREVENTION
NAME OF PROJECT 11,1\1_, L.Y o p ect Lea-F
el v`eIN,A ax-v.. T.L . 5 v10-1--i Fi.cck--h'rny\ el-Q-LIC C-2-O
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
191L-V•0"4" ef,--r•►w 4 * C--eV" f' Ye.vl C e.. 11- .i i 4'C 41.;-7 P r
NAMEPRIMARY PHONE
re, e,-e Ill 4 Civ ' :3
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR 9-- -t0 �j �31'�" r J ( i L7 �?�YerVIWYii�2�Jirr
CITY, STATE' ZIP FAX •L"yy%
WA evict)3.-2_ 2-oto " D ` z'
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Qi.ra.n-4 F 5 S* k T a '3 / 1 tJ /i_l 2,0 -tcO [O i 4-D-1-•vim'3t-.-•
NAME PRIMARY PHONE
'0..TH V,:ili ..E •.\(sTe�-{5 '1[)t,.' Ci- . -`I- t -}.
APPLICANT MAILING ADDRESS E-MAIL
•-lL214-S 8 ) r'cf, A-vsc.. S cj 0 gogo..- A:',' Sc19K.4,0,Ca
CITY STATE ZIP FAX
KA-I/4- 1A IE q I_ 2cL 1- -' c ti
NAMEPRIMARY PHONE
PROJECT CONTACT k' A t U' Ktc-' A_C46 ) t, 1-6 0D-
MAILING individual to receive and MAD.ING ADDRESS
(TheJ' ikk S. c1 E-MAIL
respond to all correspondence ZCoq ' ke�G�l r�W(;reSL�S♦e .Cl
concerning this application) CITY STATE ZIP FAX
1-0,--o-k- iA (-16b 2 Zc LP 71 T • i' c r_*:"
NAME
PROJECT FINANCING , 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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�tFo the city as a part of this application.
SIGNATURE: �1( P01 til 1" ti" gt)t;l-e1,4'JJ DATE C 3 i�S
PRINT NAME: KA-n ( O'g. -P— E12— N.)U R r i vvE F1 i2G 4 1- E
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
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(Commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
---ear
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 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
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Nc,+`=r tjIA 1 ')1A $ 0ID., . t,
EXISTING/PREVIOUS USE( )I 'L LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
I o1 cY ti . VW/V- d�—S f i0 S WZ'w1A. 1 C}— CI Yes 111 No t ❑Yes �' No
RESIDENTIAL - NEW OR ADDITION {J) /c
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE D CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION c--;.
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Construction # of
Occupancy Group(s) Additional Information
Square Feet Type Stories
TOTAL BUILDING //Dl Li z;J iv-f r;(L ,(ti,..' I f
TENANT AREA ONLY 2' ui V •,,,
PROJECT AREA ONLY fr v ' TV- 4D-i- e L
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Pennit Application