18-100727 CITY o� A
PERMIT APPLICATION
Federal Way PERMIT CENTER+33325 8th Avenue South+F �}�W�9 3-6325
G� 253-835-2607+FAX 253-835-2609 +oermitcergk a om
FEB 14 2018
PERMIT NUMBER ` Z —
TARGET DATE CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
SITE ADDRESS SUITE/UNIT#
3 ' / / 5- /67 /9v T S
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 0 � 5— .0 _.707
Sa 700 - 004/ 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ENGINEERING 2t1 FIRE PREVENTION
NAME OF PROJECT 46-5 5c:-.4 9/'P��°�-
PROJECT DESCRIPTION r J
Detailed description of work to ,, am/n•C 0/c-' SSTS,.,_,
be included on this permit only l/
NAME PRIMARY PHONE
S
,,o^, f' ' r,eT.LEpsti 90. SK00-,7$
PROPERTY OWNER MAILING ADDRESS E-MAIL
o Sox .S35oo
CITY STATE ZIP _
0 C‹../1.1_,DG.� .C'
NAME PHONE
C:r.0N
/r57.22/ 5-3 7S 5'433
MAILING ADDRESS E-MAIL
CONTRACTOR /CJ A Sr -c//7-4--. 20 0
CITY STATE ZIp. FAX
/,c;Oma G✓rV > 06
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
,9v /- 44- ? z_ ,7 iz. i 7 ,z0 .. 1,2--l03i,8-03-44.
NAME PRIMARY PHONE
$ e--.J��
APPLICANT MAILING ADDRESS EMAIL
7may/5 i'7./ ./9tt
CITY STATE ZI FAX
4. •
�8a03
NAME PRIMARY PHONE
PROJECT CONTACT ,a �0 /lS ;ic j j 9'/? ?/33
(The individual to receive and MAILING ADD ss EMAIL
respond to all correspondence 6/0_2 A, 9H 5'1- ,<-'7F 70 0 4 'y-1nJr9/,9 vi 5 4.V7:c yY,
concerning this application) CITY STATE Zip, F.vf
cn fv7 42q YCP y0�
NAME
PROJECT FINANCING ❑ 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 to the city as a part of this applicatio .
T/57; '
SIGNATURE: — —r DATE
PRINT NAME:
Bulletin#100—January 29,2016 Page 1 of 2 k:AHandouts\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)
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
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL ..Y
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
NEW BUILDING
—
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL.BUILDING /
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application