10-101123 .. RECEIVs
ERMIT
CO ME EL PL DEes—j---)E FP
Federal Way
COMMUNITY DEVELOANENT SERVICESM AR 18 APPLICATION i i
253-835.26076 FAX 25343.5-2609
wwweituoffederalwaitcom
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SITE ADDRESS
114,
/5e) ...30/ 7
SUITE/UNIT I ZONING -) ASSESSOR'S /PARCEL
ONWREPOMPSOMMUMEOPMEMMEMENt........................................................................................................................
WA'WRAWFW:#414):::::,:::*'/Ini:V::::::::aPP:0:ZgliMMI:WWw:MiNgaliagi**Mga kaia;
' NAME OF PROJECT --
(Tenant or Homeowner Name) , ....., _1. _4,,,,,, ,r r-r" fa, Pe) >1.1 1,1j T
0 BUILDING 0 PLUMBING 0 MECHANICAL.
TYPE OF PERMIT
0 DEMOLITION 0 ELECTRICAL 0 ENGINEERING l%FIRE PREVENTION
f IRQ.4 A"V2s.'A svi- goot,1
PROJECT DESCRIPTION Z9:31-1 /VI * AN Nik,1 AZ:– Noez. 2.0 •)p,) . LIL.* Set0
Detailed description of work tO
be vectud• ed on this' pernul only
.. . .. .....,,. ..,...,_ "...0 K.,41,/ ta,b#41-( P Z ,A14..... e, "7(----,,...„.........„.,....:
SUMMINOISIONMANNERNIMMEAPEOMSOIMBEIREMONEMONNIGNIONEMO
NAME PRUAARY PHONE
PROPERTY OWNER ( ) -
MAILING ADDRESS,CITY,STATE,ZIP E-MAIL
OWNER IS ALSO: 0 CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
Ft ka 4 5(1-c‹,-6/\ 1, .b19,44..woz-17.
MAILING ADDRESS,CITY,STATE,ZIP FAX
CONTRACTOR
I>.O, lam< 11231 011,twly)'I A , tA )qe.9.18( bc,)tig 2__ v.N 0
WA STATE CONTRACTOR'S LICENSE*. EXPIRATION DATE FEDERAL WAY BUSINESS LICZNSE5
F\k€31\)4A o &I,Tr 10/ / 1'0
NAME PRIMARY PHONE
-76\NA
APPLICANT Lv.A.tw",k,k10 (360 ) 79/ - Lio//
MAILING ADDRESS,crrySTATE,ZIP FAX
6330 /\( )6 n', 5i k)- oil ,uiA. 9994 i ( ) -
PROJECT CONTACT NAMEPRIMARY PHONE
(The individual to receive and
-.7-61VIA, Wkl) i 4, ( ,..,,, /A.,(L-
respand to all correspondence MAILING ADDRESS,CITY,STATE,ZIP FAX
concerning this application)
( ) _
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( )
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095)
( )
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best
of my knowledge,the Information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred
in the investigation and defense of such claim), which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises ou of the reliance o , city, including its officers and employees, upon the accuracy of the
information supplied to t. city as a pa i,f this • • ••
A /.
4 4_
SIGNATURE: A iliff AbrAr - - ..
Al DATE 3-/9-i0
PRINT NAM' 4 '41/I 'Ille
Bulletin#100–January 1,2010 Page 1 of 4 k:\Handouts\Permit Application
9
.ggiglaNi 141041- . CAt.FDC— .!!!!!
Value of Mechanical Work$ . (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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 r.ommerci4
BOILERS FURNACES HOT WATER TANKS(G.0
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
• DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
........... „
•
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Cont8o) LAVS(Hand Sink") TOILETS . WATER PIPING
DISHWASHERS ' RAINWATER SYSTEMS URINALS OTHER(Describe)
SHOWERS VACUUM BREAKERS
— DRINKING FOUNTAINS SINKS(Kitchen/maim WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES
/ GENERAL INFORMATION
• ...L.
PROJECT VALUATIO 'ATER URVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTINIRVIOUS$ Lty)z)
USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
0 Yes 0 No- 0 Yes .0 No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
•
• COVERED ENTRY
GARAGE 0 CARPORT 0
OTHER 4esibe)
TX1311110 PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL NEW/ADDITION
AREA DESCRIPTION Area Construction #of
Occupancy Group(s) Additional Information
in Square Feet Type Stories
NEW BuiLDING
..•
ADDITION
111:1111:11111111111§1E0?iiMERCISLAREISIODELITENAriTITVIPROVEMENTSEElegniiiiieggiiiiMil
AREA DESCRIPTION Area Construction • #of
in Square Feet Occupancy Group(s)
Type Stories Additional Information
• :....... . . ..........
........ • .......... .......
TENANT AREA ONLY
................
Bulletin#100–January 1,2010 Page 2 of 4 k:\Handouts\Perrnit Application