16-103495 { •
—< ` SECEIVED
''�.. PERMIT APPLICATION
CITY lfF
JUL2 0 a Q 16 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way253-835-2607+FAX 253-835-2609+permitcenter(dcityoffederalway.com
CITY OF FEDERAL WAY
CDS F �
PERMIT NUMBER /4 /_ / 0 3 L( /$ 9 5- _ - -
/ TARGET DATE C...7"."'-'...--s'*"........--D
SITE ADDRESS SUITE/UNIT$
/ 2 . 2 S , 1)r1-1- 2q.L)
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
$ I,6o 6 9 2 1 O 9 - �'2 0 8'
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING cl FIRE PREVENTION
NAME OF PROJECT Y V l a V 1r I. • L-ar d/t rGt Work__
PROJECT DESCRIPTIONAdd. <�� u pr l✓hics aril dd C�) f t
Detailed description of work to
be included on this permit only
PRIMARY
NAM
/ '� 1/I ll S•ii rj- Pr eS ,i'�3 2/2•.29et,
PROPERTY OWNER MAILING ADDRESS E-MAIL
\\2\ �W S r ren. SV, 1-1100 -54cvf)-r? l rsh.COii
STATE ZP1O/ is j _ 172-05 7-
C' I wn D Troirc-hhcx) , Vic_ y2<•4g/•76677
MAILING ADDRESS MAE-MAIL
CONTRACTOR 1 O?S CI1� c via e Crown �Ofr
CITY STATE ZIP 1 -
YY) ;1 I OreeK-__ r2
WA STATE CONTRACTOR'S LICENSE t EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE$
CZAwgNF�,,, 4i-IL /� °i //0 / 17 /9.4 7c Slolo/-d0•R4
NAME � PRIMARY PHONE
1 e iQ. a S con / P '-
)O
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT N fA f!l (AS COfl aC- tel"7 - PRIMARY PHONE
(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 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 supplied to the city
/assf(a part of this application. i
SIGNATURE: Ca�- jDATE 7' 18'•{69
PRINT NAME: jeS7I CGt ROb1ficSI// /
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
9
• S
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
, 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 rub/shower Combo) LAVS(sand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Lasky) WATER HEATERS(Elecrric)
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)
SECOND 1;1 - 4
COVERED ENTRY
GARAGE ❑ CARPORT ❑
OTHER i s
Area Totals
EXISTING PROPOSED TOTAL -
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Construction #of
OccupancyGroup(s) Additional Information
uare FeetType, Stories
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area OccupancyGroup(s) Construction #of Additional Information
Square Feet Tie Stories
•
TENANT AREA ONLY
Y ,
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application