15-103868 C2Y\C.- ECEIVED
II\ II
CITY OF AUG 11 2015 PERMI PPL TION ,i
Federal Way Olt' �4ti
CITY OF FEDERAL WAY V
ItSkN% 1,114\
PERMIT NUMBER 1 5 _
— — T GET DATE
SITE ADDRESS 2......64 l) ` P-- SUITE/UNIT#
Licil
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# �/ e
$ 6)0a) X'S 7 Z 7 5 7 5_ C / - 0 C5 0
f'
TYPE OF PERMIT ' UILDING LI PLUMBING 0 MECHANICAL 0 DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT 50/t(/�)// ?Oar �(v
C ,:;) - Af fe7 43- ? c,
Apt) /a . "x z5-11:-0 JuA' (rII�irc /71"Z1.)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER /A4/co C sjpis®//Y _
MAILING ADDRESS E-MAIL
11 Li 1 \ 9 CITY STATE d ZIP 66
y
NAME , PHONE
C� d'ch,p4 ,+G4 (>0,--cam L 243- 4,17_ /7 Zo
MAILING ADDRESSij �t E-MAIL
�f
CONTRACTOR / / /=t K— kJ I .�-7 ...44.47i0:\.4-e
CITY STA.TFr ZIP 75 3 FAX ( A74
WA STATE NTRACTOR'S LICENS # //"_�1 EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
� �57c �'7 Ai 019 / -- /ZD/7 _
NAME Y PHONE
(7-� /f PRI 29,-- z ?--. 539L
APPLICANT LING ADDRESS E-MAIL
f' tCi- c r a 4- C - ,
I g 1 g c! CITY
?Y.()
O -4- STATE ZIP
r 5‘Vy FAX
24` /-/Z 8C
NAME PRIMARY PHONE
PROJECT CONTACT 2' My
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
/�/C / .— C�7�ev7 `/
concerning this application) CITY -A
/ STA/EA ZIP a FAX
//V [/ v
NAME //
PROJECT FINANCING 0 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 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 - ance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a pa is application.
SIGNATURE: DATE
PRINT NAME: . 7" l5'
Bulletin#100—January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
f/ (A1t VALUE OF MECHANICAL WORK
IMECHANICAL>PMIT � i )
Indicate�tnany of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain_
AIR ING UNITS' r 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 A4( ,4 $
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
1�0 Lv1> LUE> $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLE YSTEM? PROPOSED FIRE SUPPRESSIOYSTEM?
�j psi 4,ClOr1 , ❑Yes No 13I�
Yes No
(/Y �Com/+ 1 0
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
y
3. rr,,, ;,/. ✓°-/fr
4,A; f;r f%```Xc� i,'f y r^,,/iv ! . kik.;%✓��/_ �1 ./,�V//r. ......._....._.....—._._--._—_—_..__.....__......._.. ._.._...__—__._....__._....._...
FIRST FLOOR(or Mobile Home) I( 2 tflCo
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
1?r,
r /
EXISTING 2;77 TOTAL
Area Totals
**SEW BOMBS ONLY*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
N rL BUiLD;NW';/ ,ar; //r% f"% / r ,,; ,, ;�,, / �'! /rr.,. ,,///
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area Construction #of
AREA DESCRIPTION Occupancy Group(s) Additional Information
in Square Feet Type Stories
ToiAL BUILDING / ' ' ✓ r ''% r / r „/ i
� r ff ,moi //
TENANT AREA ONLY
,' / r h r, rte: n' d^ / i r
PROJECT�ONLY."
F �
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application