18-101862 4.,
ilkRECEIVED
CITY PERMIT APPLICATION
Federal Way MAY 01 2018 PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +perrnitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER l q _ 1 0 1 (a 2 _ F T /` 1 A
TARGET DATE `
SITE ADDRESS SUITE/UNIT#
M
2 098 5, 337 ` S t Fed'emi Way W Iik 9800 ?
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL D DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT LL M ft 66-i.g_Nry r 7 1--C-6,1--C-6,1--C-6,
/t(A 5Lip 0iv-CS: I"
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
Lk.. YY14114 y ..e"i--
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME PHONE
4R Row Fr`ev.._ pmledic -N `l�S-30/ -8707
MAILING ADDRESS E-MAIL
CONTRACTOR ?a`1 i 0/04,in Vi E'(..../ If1 v� a ri-o,J.J.1/4 c yra,s;),6o,�.
CITY STATEZIP FAX
E//P dki W�STATE -..
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
4PROW FPI L11 'Pk /2 / 31 /2Oi
NAME PRIMARY PHONE
.ri 1W fl 0191 1/ .r-3o/ -g1v-
APPLICANT, MAILING ADDRESS E-MAIL
10), f. mc,,J ,c1;,vl'ew i41142- Af towJ�J/4 �lfi+ho a
CITY STAT ZIP r l•L D
Ell �sbve w 9592-e FAX
NAME PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 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 b st
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 incurre in
the investigation and defense of such claim), which may be made by any person,including the undersigned, and filed against the ty,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of he
information supplied to the city as a part of this application.
SIGNATURE: ..... .. .....r.:4 1...._ DATE —/ — 2 D)g
PRINT NAME: -J 5---/
Sp1(.J d/v by
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
I 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)
DRAINSSHOWERS 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
$. ....
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No ❑ Yes ❑ No
RESIDENTIAL — NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
...............................................................................................................................................................................................
BASEMENT
FIRST FLOOR(or Mobile Home)
................................................................................................................................................................................................
SECOND FLOOR
COVERED ENTRY
...............................................................................................................................................................................................
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**xEur Burgs Omy**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in Construction #of Additional Information
AREA DESCRIPTION Occupancy Group(s)
Square Feet Type Stories
NEW-BUI DIN .,.;....;....... s ,. __
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area in Construction #of Additional Information
AREA DESCRIPTION Occupancy Group(s)
Square Feet Type Stories
TO'f AL'BUILDING`
TENANT AREA ONLY
PROJECT AREA ONLY . ,..
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application