09-104964 T
09
RECEE
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CITY OF ` DEC 21 SF MF CO ME EL PL DE E FP
Federal Way
PERMIT
COMMUNITY DEVEIAPMEN[,EFV OF FEAT I O N K / /253-835-26070 FAX 253-8www.cilyoi/cderahnau.mrn CDC
,-4;,.L; PROPERTY
Y
DRESS
1511 31N'th Si-
TE/UNIT
AZONING ASSESSOR'S TAX/PARCEL#
I5—o5 ? 8 9 7 00 _ 00 )- 3-
PROJECT
NAME OF PROJECT � � /,,
(Tenant or Homeowner Name) k(Ay() UUI 1k/ H6+"k
❑BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL 111 ENGINEERING lid FIRE PREVENTION
CAVI II O Caive yowl; .ii YL A-a✓wl. -
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PEOPLE
NAME PRIMARY PHONE
PROPERTY OWNER SO H-'i s y 1�I-Il a 1 Iv ( )
MAILING ADddRESS,CITY,STAT!,ZIP E-MAIL
0.165' 301 ' - 5E
OWNER IS ALSO: [] CONTRACTOR 0 APPLICANT 0 PROJECT CONTACT
NAME PRIMARY PHONE
dire sysle is 1desi ( 253 ) 833 - 12y6
CONTRACTOR MAILING ADDRESS,CITY,STATE,ZIP FAX
206 fra► e Rlt Noy (243 ) '735- -0113
WA STATE CONTRAC'FbR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
FuE sL,Jr INOgi 12 / 31 / 10 19- £s7-0060114-00-tgL
NAME (��� PRIMARY PHONE
APPLICANT 1{ &$ `"n1t ( )
MAILING ADDRESS,CITY,STATE,ZIP FAX
( ) -
PROJECT CONTACT NAME l PRIMARY PHONE
(The individual to receive and � 'O I)c1+J1( 1-IAM ( )
respond to all correspondence MAILING ADDRESS,CITi.STATE,ZIP FAX
concerning this application) ( )
ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL
( ) -
PROJECT FINANCING NAME
I5/OWNER-FINANCED
Required for projects with
value of$5,000 or more MAILING ADDRESS.CITY,STATE,ZIP PRIMARY PHONE
(RCW 19.27.095) ( ) _
I certify under penalty of perjury that I am the property owner or authorized agent of the property towner.I certify that to the
best of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply
with all applicable City of Federal Way regulations pertaining to the work authorized by the issuance of a permit.I understand that
the issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred
in the investigation and defense of such claim),which may be made by any person, including the undersigned, and filed against the
city, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: fillo.i 4 DATE ‘ 2 I Li 101
_.
PRINT NAME: M1 �t.
Bulletin#100—4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
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011
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MECHANICAL FIXTURES
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number 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 OUTLEIs OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS)Commercial)
BOILERS FURNACES HOT WATER TANKS(cos)
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(or9ub/Shower Combo) LAVS)Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/ut(11ty) WATER HEATERS(Eiectrlc)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$ 5,100 $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No ❑Yes 0 No
RESIDENTIAL
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of
Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—4/21/2009 Page 2 of 4 k:\Handouts\Permit Application