15-101001 f r
CITY OF acme') PERMIIA
PPLICATION
Federal Way MAR 0 3 2015
CI F F Lei/V7 p
PERMIT NUMBER / _ DD _ AO
✓✓✓ TARGET DATE �A
SITE ADDRESS SUITE/UNIT#
33°I 19 15-k Wau, Zak/14A Sv tc' ZO N RAG
yed Wal 1800 3 2-0
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ $ e0v °► o I l 3 - t s o N
TYPE OF PERMIT ❑BUILDING PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT b( extoctq nerS - f o W 01
SNSk PI..w.ipi h for I —To;k.+ ev J 1 -sr"( i h
PROJECT DESCRIPTION T. 9
Detailed description of work to ! 5 Aug-
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER CVAA tM )AtMe,Ak coy
2633 EtMAILING ist Laws. Ot k) S,. SOD E-MAIL
CITY STATE ZIP
Sce.i'f'1>L Wgtts4 "
�1 PHONE +�
NAME �OLh` v� i� 925-/�1�G-10‘97
MAILING
ADDRESS E-MAIL
J
CONTRACTOR 1"0 c3o K 1119 Co Swt k,o a Cern cnt54-
CITY STATE ZIP FAX
M4Wle. VAIN wA `tga3�f `I*-`t13-8ytsi
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE 41
LocAlikovj?q %/ 23 15
NAME PRIMARY PHONE
606 Sa*K-0 y?$ -1.0S•64.417
APPLICANT MAILING ADDRESS E-MAIL
('o $o x I/t% 544140 @_CoMc cS-.Welt-
CITY STATE ZIP FAX
Maple_ Va,ilei W Oc. 9803 i{?,S-y13'��f�7
NAME PHONE
PROJECT CONTACT &O b SO-A-K-00 11 5
-115.7.•(c41-11
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence (O ibO) to sAtPO 'OMCA3
concerning this application) CITY STATE ZIP FAX
.arvle_ kie lt( to g8o3fj tii5-'f1 '-'8‘16--)
NAME
PROJECT FINANCING tSk. 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 authorised 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 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 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 application. 2,
SIGNATURS-16r— DATE / "(�
PRINT NAME: &I, ' A tle-I9
Bulletin#100-January I,2013 Page 1 of 3 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 menial))com
BOILERS FURNACES HOT WATER TANKS�caa)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $ 5 b0 D
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 1ub/shower combo) I LAYS(Hand shdra) _ LTOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINSSINKS(Kitchen/Unc)
hen/Utility I WATER HEATERS(eectr
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
l EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes❑ No ❑Yes ❑ 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)
sRi8TRf0 PROPOS/0 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 FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area Occupancy Group(s)
ConstructionStories Additional Information
in Square Feet TYPe
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2013 Page 2 of 3 k:lHandouts\Permit Application