18-101479 R� L.: ED PERMIT
CITY OF „„.....‘ APPLICATION
APR 0 5 2018 PERMIT CENTER+33325 8th Avenue South +Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenterljcityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER /$7 _. / b / zi 7 q _ r /0 TARGET DATE C
SITE ADDRESS SUITE/UNIT#
2-ca I ',Ai' 5-c7+4•- 4'r q So 2.3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ f Z 2- 1 0 3 - 9 ( c. 2_
TYPE OF PERMIT D BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 'i E PREVENTION
NAME OF - i c, 312.•- . y 'a ''w• 1 '. 1,4 PO a
I
PROJECT DESCRIPTION N AL N jt/ - Ic,�r( r`IC� ��Aip2
Detailed description of work to KS-Ty"1 13'/ b Q�v�1) Ty�' - I 3 D 2.--4:›i
be included on this permit only
NAME / PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS �w � E-MAIL
V I` ' `h..
CITY STATE ZIP
NAME PHONE
C �( � 1912,...-rat.--77a^J *Ls 3-2-02-341.cs9
MAILING ADDRESS X E-}�L,
CONTRACTOR PO � l� Cf '1 d r 1. e rs�
CITY •POV
d p STATE1 ` ZIP_s-3-1/ FAX NI Pc- p rte.C z,i.
WA STATE CONTRACTOR'S LICENSE# vv CCEEXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CAS6-d4 tP $33 L 2`
NAME PRIMARY PHONE
&M't {AS c Tf CTcaQ_
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME PRIMARY PHONE
PROJECT CONTACT licikV U) `-°(Tk ZE'3-- V-'02---3/ V e'
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 'f.c14- S (.15-g1 '2_,
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING Er OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 d- ense o ch claim), which may be made by any person,including the undersigned,and filed against the city,
but only where such 1.im • - out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied % the c • ;a part of this application.
SIGNATURE: — DATE 4-5=113
PRINT NAME: qii '. •'-a
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)
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? I WATER PURVEYOR I SEWER PURVEYOR I VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(1n Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes o No o Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square fePt) I EXISTING I PROPOSED I TOTAL I FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
................................................................................................................................................................................................
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
1 Area Totals I
I **NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ 1 # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in Construction #of
AREA DESCRIPTIONOccupancy Group(s) , cr Additional Information
Sgnare FI,�rnp
'PPM: -rr., uric£
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