10-103840 • ` S Io _ Ja38" 4a
ANSI..
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CITY OF
Federal Way PERMIT
sIRE C EI V DEN FP
COMMUNITY DEVELOPMENT SERVICES APPLICATION V C V
253-835-2607•FAX 253-835-2609
uww.cityottederalwau.com zi
�77,,
L SEP 0 9 2010
4
f
SITE ADDRESS _ CIT 0 F FEDr &WAY
10L{5 S • 3 '^ St • CDS
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL M
$ qc6 50•C)--D -IO O Z. a l O `k - 9 SZ m_ '_
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING 9 FIRE PREVENTION
NAME OF PROJECT n
(Tenant Name/Homeowner Last Name) t-1 ce Ca_✓e Ce v4`Ee-v T T. t. • (>(G '45 ?rote e.*i o 0c2 -2'loo r •
PROJECT DESCRIPTION Acid C8) ' )ri vtkl-e✓s I v. 1-t- Vcw
A-L-F- I mproVry,t
Detailed description of work to
be included on this permit only
NAME f PRIMARY PHONE
PROPERTY OWNER L' eCG.✓e. Coh lAjebcs, ,* Ce.AAce 253 •j'(! • 1-Z*'3
MAILING ADDRESS E-MAIL
l045 S, 30$4-k St.
CITY STATE ZIP
tdera.I /IlJa.1 WA 1$003 PHONE
NAME 51�p(eg.GT(hnell O 2O` .act 1' Ct€06
CONTRACTOR
MAILING ADDRESS'1520 (0�'^ QVe r7• , S to 1+e (00 E-MAIL
O CITY STATEZIP FAX
$ec.:1l•l-e 61$lO`C 20(o•act t•tSco
01%ti
WA STATE CONTRACTOR'S LICENSE N EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
NtPLL-•t9g$B(r I / t I / 12 l�1-`lei IUSB'l�i-oo at-
NAME
c'tPHONE
SLIM Loc G�ihr.1-\ '100' .2`l • LI{00
l
MAILING ADDRESS E-MAIL
APPLICANT
61520 1,to Ave 5. „Sw,te 100
CITY STATE ZIP FAX
Srr.-14 l r w A '(1lOid aot.•act t• 1500
PROJECT CONTACT NAME 1Si-e-1.016c /�,. PHONE p
(The individual to receive and .J&t e-t n5 • `� impI"Ic - iVtYetlk ao(,•act(•ll't.(o0
respond to all correspondence MAILING ADDRESS E-MAIL
concerning this application) 95oZD lb'-`` Ave S• So:kr to() l&S'laleloir5e Simp1elclr:wneU. An
CITY STATE ZIP FAX
Se 4.+4-(9, wit . 1gl015 3-o6•aotl• 1Goa
ALTERNATE CONTACT NAME: PHONE E-MAIL
A&0.-44-l%.t.IA) Bo • S;I••p1. '&i ull aob•ocil• 14.132-- Mboe&s1/•9luclr;►.„ea•cow,
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS.CITY,STATE.ZIP PHONE
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 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.� q/
SIGNATURE: ` /_I7r. Jik4,0C 4 I 01112.1( DATE //43/16
PRINT NL!11VII1`: Jia hel- Ste-bbJ H.S ( !!
Bulletin#100-April 14,2010 Page 1 of 3 k:\I-Iandouts\Permit Application
• i
MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fvctures 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
PLUMBING FIXTURES
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(orTub/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
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE Cl CARPORT ❑
OTHER(describe)
EXISTING PROPOSED 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 Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY 4OO
Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application