13-105623 • •
CITY OF PERMIT APPLFATN
Federal Way
I l//n DEC 18 2013
PERMIT NUMBER ` 9 _ 10 5 `� Z 3 _ FF'
TARGET DATE CITY OF FEDERAL WAY
CDS
SITE ADDRESS SUITE/UNIT#
j-z-CSO S. 3 14-1\ 5.1-
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 2S, 500 U `t Z l a 4 _ 9 O 3
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL ❑DEMOLITION ❑ ENGINEERING XFIRE PREVENTION
NAME OF PROJECT (1,3` L,ASM P
PROJECT DESCRIPTION Asti Et QE LO L A TE, o z,J`. c.,.._ l.)� J -71.
Detailed description of work to Qi) N -10-) 'DOO'DOaLE -i-N C t-oii-- �' - Ncric *S "6a_ Fere E.Z Eet_
be included on this permit only
NAME. l PRIMARY PHONE v
PROPERTY OWNER 11114-Sr t)€ r t.A2A-
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME . PHONE
Ct
o l.v Me I A- I—. Zoo 2-37- i; 01'
MAILING ADDRESS EMAIL
CONTRACTOR t(` 5. `.i ool.A`1 S i 6.11es-L CcW.me,A FOE_Ifgr-
CITY STATE ZIP FAX
A-11- Loa 9uuo£5 Z04 34,a 41o®
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CC)U.> IhFtq;Pz1A L- 1 / t5- / IS-
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS M{/v E-MAIL
CITY 5fr STATE I ZIP FAX
NAME ) PRIMARY PHONE
PROJECT CONTACT NC& �ill Lk 641a4tAlos) Zo4 13 2 Vs-4.9
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 27-00 — "'" j = — �
concerning this application) CITYSTATE ZIP FAX
`rt I 2-A t, vv-A-1----------VA-
NAME
v 'r ------A-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 reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t cit as a art of this application.
SIGNATURE: / --- DATE /I/1 (1/3
PRINT NAME: 1�K t e1A r/b 2.
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 offacture to be installed or relocated as part of this project. Do riot include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commeroial
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 offixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/shower Combo) LAVS(sand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS Kitchen/utihry( WATER HEATERS(siecire)
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)
E7387RN0 PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area Construction #of
AREA DESCRIPTION Occupancy Groups) Additional Information
in Square Feet Type Stories
riEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TE.NANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
is Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 1,2013 Page 2 of 3 k:\Handouts\Permit Application