09-103843C
CITY OF �- ERMIT
Federal Way.1.P
COMMUNITYDEVEIAPMENT SERVICES C` PP ICATI
253-835-2607- FAX 253-835-2609 1 n
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�- 103 -3
SF MF CO ME EL PL DE EN P
ON
S PROPERTY
SITE ADDRESS
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SUI�TE/UNIT #
ZONING
ASSESSOR'S TAX/PARCEL #
y
PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name)
/
1 1 } ; -S� ,-1 -J, 1..., L-P.i zx
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION El ELECTRICAL El ENGINEERING XFIRE PREVENTION
PROJECT DESCRIPTION
A /
�'" n rrJJ Prier (vVn,;Q C re- 1,AC
Detailed description of work to
be included on this permit only
b uj � , n (_ f) n e_cA I &Y \
PE LE
NAME
PRIMARY PHONE
PROPERTY OWNER
t l'L)I ti --,)r-f-V IL e- Co") I C-(
MAILING ADDRESS, ADDRESS. CITY, STATE, ZIP
Oox a.. y 9 r I Mrd wd WA 9 O93 - 0699
F -MAIL
❑ CONTRACTOR APPLICANT PROJECT CONTACT
OWNER IS ALSO:
NAME
o to iy) L •
PPRIPJAARY PHPHONEU
�
(�S3) tl 7L - 669
MAILING ADDRESS, CITY, STATE, ZIPW,,-,WA
6(ix H �{i ''' '''' /� /�
WA 9?06 )
F�
i73 � 7I
CONTRACTOR
..J �jcr) Wr.
(W.yy )
-
WA STATE CONTRACTOR'S LICENSE #
LLOYQs-4 037613
E%PIRATION DATE
y � ��
FEDERAL WAY BUSINESS LICENSE #
,a�) 30► ���� 00 i31
--
NAME
PRIMARY PHONE
APPLICANT
MAD.ING ADDRESS, CITY, STATE, ZIP
FAX
PROJECT CONTACTNAME
(j
� '` �j f-.� )'It -IL, sJ'AV2. &VM A r
�PRMARY PHONE
('J
(The individual to receive and
MAILING ADDRESS, CITY, STATE, ZIP
P6 (3e,,X 33 f-tAtr , �,` 1� 91063
FAX
(Z3 ) X37 - (3 1 J 3
respond to all correspondence
concerning this application)
ALTERNATE CONTACT NAME:
PRIMARY PHONE
( )7 q - 669
E-MAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Requiredfor projects with
MAILING ADDRESS, CITY. STATE, ZIP
PRIMARY PHONE
value of $5,000 or more
(RCW 19.27.095)
towner.
I certify under penalty of perjury that I am the property owner or authorized agent of the property 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 fye city a part of this application.
Ili LCI -
SIGNATURE:DATE
S
Sk ye, f3 -.,Ary). ✓1 Z—JoN� : /? ie, f) f! y r'. J Te, C
PRINT NAME: r
Bulletin #100 — 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
Indicate number of each type c
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
_ DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
PLUMBING
MECHANICAL FIXTURES
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 (Commemia))
BOILERS
FURNACES HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
Indicate number of each type c
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
_ DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
PLUMBING
FIXTURES
to be installed or relocated as part of this project. Do not include
_ LAVS (nand Smks)
TOILETS
_ RAINWATER SYSTEMS
URINALS
SHOWERS
VACUUM BREAKERS
_ SINKS (catcher,/utility)
WATER HEATERS (Electric)
SUMPS
WASHING MACHINES
ifixtures to remain.
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
--
$ y /5 U 00
Additional Information
NEW BUILDING
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
❑ Yes o No
a, Yes ❑ 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 ❑
.............._............................................ __........ ..................... _......... _...................... _..................... ,..... _... _....................
.
OTHER (describe)
........................ ...... _...... ..................................... _................................... ....................... _............ ........................... ............
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Group(s)
Construction
TypOccupancy
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
in Square Feet
Group(s)
Construction
TypOccupancy
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application