15-103902 edili,
4111,k
CITY OF ` �" PERMITPPLICAZ'ION
Federal Way AUG 0 7 2015
CITY OF FEDERAL WAY
r-....,,............,j
PERMIT NUMBER /5 _ �Cr5 `% 0 ,2 _ F10-
��,� ( TARGET DATE
SITE ADDRESS 3 2 �`'j` ((j` SUITE/UNIT#
•ROJECT VALUATION ZONING � �SSESS i R' TAX/PARCEL 3c
/49S d? e) — - - - - -
TYPE I • •4 IT ❑ BUILDING D PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING IRE PREVENTION
NAME OF PROJECT ; e0'1 ( -1 k A -- L�..'
AIA.Tv 1N c.� tlyt .5-i { ri 1 •s 2 Yt...
PROJECT DESCRIPTION 11 (�
Detailed description of work to
be included on this permit only
NAM r L 4\4--
LLPRIMARY PHONE
PROPERTY OWNER
MAIL NG AD S
E-MAIL
CITY STATE ZIP r
NAME -•�•� n '�1r 1._�,.f PHONE
G DRE33 '' `` E- L
CONTRACTOR I�l t r,, @ �w l 1 e`)
C�� J i ILL 'rt- STATE t_21,o 1 it,o) �3S —LinC�
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE F DERAL WAY BUSINESS LICENSE#
Lt0l.11M (yA (P 5/,3 /( (o
NAMECArex; tt PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
�G�
CITY-et
i• STATE ZIP ie.l l�41�- w, ,�1 I '
N j PRIMARY PHONE
PROJECT CONTACT C)(AL1 J C�WL f 4� `
•
MAILIN DRESS
(The individual to receive and E-MAIL j� Y`�.,
respond to all correspondence ►1� �cGf`
concerning this application) CITY STATE ZIP FAX C1/•--
NAME
1/\.,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 c arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied o t city a of this pplication.
r 3 SIGNATURE: &-f DATE \c I 1
PRINT NAME: C)(a 13
?`
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
• •
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of facture 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(cas)
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 ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
/ b y ' • i.. ,;/; / f'� / "z.. j/ //
,
COVERED ENTRY
GARAGE ❑ CARPORT ❑
ETHER(des — —............._....._
EXISTING PROPOSED TOTAL
Area Totals
//:,/'4,,/, "ti&W HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Occupancy Group(s) Construction #of Additional Information
AREA DESCRIPTION Area p y
in Square Feet Type Stories
7. // / . F f�+ /
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Occupancy Group(s) Construction #of
AREA DESCRIPTION Area p y Additional Information
In Square Feet Type Stories
TENANT AREA ONLY
P,ROJECT AREA ONLY.
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application