13-103503 ACIn OF • PERMI i PPLICA ION
Federal Way RECEIVED
10 O. ?- F {>
AUG 0 8 2013
PERMIT NUMBER _ CLatam C, /
A
CDS �/
SITE ADDRESS ''^ QUITE/UNIT#
%23 IS` � -S. Axa\ \IkW\ � igoi 11 14-4--
PROJECT VALUATION ZONING ASSESS R'S TAX PARCEL# C �\
$
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERINGFIRE PREVENTION
NAME OF PROJECT / /AL/ 3
e:(pec- � fir`c, ��c7,41 Low),tin/64_1(Y
PROJECT DESCRIPTION r �/
Detailed description of work to J r lG A-4 ,e4,4,„)
be included on this permit only A r )/ (
NAME 1 PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME �i��,{�' PHONE
Fire King of Sea,►ladn�' f J J
MAILIN uth Holden Street
E-MAIL
CONTRACTOR ��}�Seattie, WA\, 98 1 U STATE ZIP FAX
CITY
uO6\J 763-4177 c' 2
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
Fire King of Seattle, Inc_ 206-1 3 L*\T7
APPLICANT mAiL Seattle,�th Holden Street E-MAIL
CITY WA 98108 STATE ZIP FAX
(206) 763-41771 PRIMARY PHONE
PROJECT CONTACT N USW�`ZI11�C ( 25:37,J�1 Mea
(The individual to receive and MAILING ADDRESS ������(( E
respond to all correspondence ,CIS(it J�� k\M ;\Jt
concerning this application) CITY STATE ZIP AX
NAME
PROJECT FINANCING ❑ OWNER-FINANCED
Required value of$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 arty 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 ap lication.
SIGNATU' „0.0°9- / DATE g///„„w-5,7:5
PRINT NAM D. Z'%1/1
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
411)
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)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type offixture 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
OOFEXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
4/Yes ❑ No ❑Yes j" No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
4,4144
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSES - - TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application