14-104889CITY OF 11
Federal Way
PERM11MMUPLICATION
SEP 2 3 2014
PERMIT NUMBER CITY OF FEDERAL W
_1-�/ -F— SZ � TIMST DATE .....----- ------ -- - ---
SITE ADDRESS
SUITE/UNIT #
asoma_ s 3aa�►� 5�
PROJECT VALUATION
I
ZONING
I
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
-t-
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING IREPREVENPION
NAME OF PROJECT
LR) L WA 6 CE�4 T� K
I-
11 b S s A%, s s. t� c
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME` w� ��hL
PRINIARY PHONE -- - ---
PROPERTY OWNER
�L ��LI _ t 3�O1 N l i£ (y ice/
MAILING ADDRESS
E-MAIL j
..1a EA -i4 v,r- a6o0
CITY
5i�A%,u-
STATE
I�,rh
ZIP
fto 1
NAME
iE�iJ5LAas F.19C 1 u IEmo nl
PHONE
4�58`01- 0100
MAILING ADDRESS
14640 AX 551h 31 X 101
E-MAIL
5o\- ,.LA4W w5fQ,Us
CONTRACTOR
CITY
F'Ro\0vO
STATE
I WA
JZIPPAX
4605x.
LilS-6161-3o3o
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
WLsTkSF906Pj
NAME
5r4AWD F
PRIMARY PHONE
LJaS-^iS'61 07
MAILING ADDRESS
1Li00 Nb 1511A $ *-10 1
E-MAIL
Sr�N,� +v5 irk
APPLICANT
CITY
?\1LbN0t,0
STATE
I WA,
ZIP
gbCS-.k
FAX
Lbs- v -�39
NAME�TM
PRIMARY PHONE
PROJECT CONTACT
415- 4106-910
MAILING ADDRESS
14 b
E-MAIL
(The individual to receive and
respond to all correspondence
E-10\
�
CITY
STATE
2IP
FAX
concerning this application)
rr
LU
W'
ri�
[ p
"l�J' -V - Q
PROJECT FINANCING
NAME
OWNER -FINANCED
Required value of $o, 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 n
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 apart of this application.
SIGNATURE: --q--,, -.. - - ----- - - -- -- --- ----- __ DATE --
PRINT NAME ,-11J--
Bulletin ii100-Joiivary 1, 2013 E'ag" 1 of 3 k:llfzn,lou[;AFe miI 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 inchlde existinq ixtures to rernairl.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTI ER (Desa:ibe)
AIR CONDITIONER _ FIREPLACE!NSERTS _ HOODSIc"'M"-,n
BOILERS FURNACES GIOT WATT R T;1NKS Ia,,'I
COMPRESSORS GAS LUG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFOR:NIATION
va r
rr; or Pi r n: r,c wopx
PI.,I;Kl1ji1NG PERMIT
_
# of
$
LOT SIZE IIn Square Fect)
Indicate how many of each tilpe of
-
fixture to be i71s10111 d or relocated as part of this project. Do riot include existirty fixhires to rernairl.
BATHTUBS("un/snoaer c,,,,,eol
LAVS )il—d S,,,r.,i
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS
WATER HEATERS (Eie,c)
ADDITION
HOSE HIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFOR:NIATION
CRITICAL, AREAS ON PROPERTY? WATER PURVEYOR
SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Construction
_
# of
EXISTING/ PREVIOUS USE
LOT SIZE IIn Square Fect)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
COMMERCIAL - NEW/ADDITION
Area
Construction
_
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
in Square Feet
Type
Stories
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS_
Area
_
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
in Square Feet
Type
Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY 1----------
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111111C1111 #100- January L -1013 of' 3 k:AHandouts\Permit :1\ppl kation