18-102537- - , 'k
CITY OF
Federal Way
RECEIVED
JUN 11 2018 PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenter(c)cityoffederalway.com
COMMUN[TY DEVELOPMENT
PERMIT NUMBER / I _ / —0A
A 5— 1 _ _rp—
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
.?- v Z 0 S' 1''`� S ;7',
PROJECT VALUATION
$
ZONING
ASSESSOR'S TAIL/PARCEL #
CJ �- j - 1? 7
f i n c v
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING xkIRE PREVENTION
NAME OF PROJECT
C' &,A, t % C— re— Pq Z /I T C
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME y� / / / A 1 L^ .' `�/�-
PRIMARY PHONE
Ou ( ,— /
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY S C
STATE
ZIP
N =
S / "' L (� �-
PHONE
MAILIZ/6 g �U U� • �.�j `''rte
CONTRACTOR
CI
v a t��Z �C
STATE,"
Aj E
Ii4
ZIP V In, GL
�•
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
14Z� = c
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
,! C_
L VC
PRIMARY PHONE i
PROJECT CONTACT
1 (_
MAILING ADDRESS
E -MAH
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
1 certify under penalty of perjury that I am the property owner or authorised 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 authorised 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 supplie the qty a part this application.
SIGNATURE: DATE
PRINT NAME:
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 offixture 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
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION Area In Occupancy Groups) Construction # of Additional Information
Sauare Feet Tvve I Stories
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Sauare Feet I I 'love I Stories
TENANT AREA ONLY
Bulletin #100 -January 29, 2016 Page 2 of 2 k:\Handouts\Pennit Application
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how ntany of each type offLxture
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 XNo
❑ Yes ❑ No
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION Area In Occupancy Groups) Construction # of Additional Information
Sauare Feet Tvve I Stories
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Sauare Feet I I 'love I Stories
TENANT AREA ONLY
Bulletin #100 -January 29, 2016 Page 2 of 2 k:\Handouts\Pennit Application