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09-103738
RECEIVED BY 01 COMMUNITY DEVELOPMENT DEPAIs R Fe SEP 2 $ °2009.— - � (2 -3 -7 aff Of APERMIT EN Federal Way SF MF CO ME EL PL DE COMMIJAMDEVELAPMENFSERVICES APPLICATION 253-835-2607• FAX 253-835.2609 www.cituoffederalwau.com PROPRRTY SITE DRESS ' / ZONING ASSESSOR'S TAX/PARCEL # f`l O J PR03ECT NAME OF PROJECT (Tenant or Homeowner Name) ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL TYPE OF PERMIT ❑ DEMOLTYION ❑ ELECTRICAL ❑ ENGINEERING *FIRE PREVENTION i PROJECT DESCRIPTION Detailed description of work to be included on this permit only .. .., . _ ; .. PROPLE ... NAS �y °©t PRKM ART PHONE 1 S-3 PROPERTY OWNER (' (� f <C l h 5 n l,d 7(7 l MAUJNG ADDRESS. CITY, STATE. ZIP 4) [ter 04 9 E-MAIL 0 CONTRACTOR 0 APPLICANT IN PROJECT CONTACT OWNER IS ALSO: NAME PRDAARY PHONE MAUJNO ADDRESS. CITY. STATTE. ZIP F fES � FAX 4/c x lvo, s� JG t ( ) WONTRACTOR A CONTRACTOR'S LICENSE # EXPIRATION DATE . ?7 — FEDERAL WAY BUSINESS LICENSE # O -3rl NAME PRIMARY PHONE APPLICANT NAILING ADDRESS.CITY STATE. fiP //,�� 1` FAX PROJECT CONTACT NAME ' PRMARY PHONE (< �) ('The individual to receive and 7- a t � G ADDRESS, CITY, firrAIN ZIP 3 FAX respond to all correspondence conceming this application) )- -f ift-4 p ALTERNATE CONTACT NAME: PRIMARY PHONE E-MAIL PROJECT FINANCING OWNER-FEVANCED Requiredfor projects with MARING ADDRESS. CITY. STATE, ZIP PRIMARY PHONE value of $5,000 or more (RCW 19.27.095) ( ) _ I cert(fg under penalty of perjury that I am the property owner or authorized agent of the property owner. I oertl/y 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 taws regulating construction or env iroal laws. Ifurther agree to d harmless the City of ay as to any claim (including ousts, expenses, and attorneys' fees incurred in the investigation of suc , whic be made by any person. including the undersigned, and filet against the city, but where claim arts o rel the city, including its gQ4cers and employees, upon the accuracy of the information pl the city as a o SIGNA DATE PRINT NAME: (S t{"✓l- + t'( Bulletin #100 - 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application PLUMBING FIXTURES Indicate number of each type of jbcftwe to be installed or reloc as part of this project. Do qot include existing fixtures to remain. BATHTUBS (or Tb -r Combo) LAVS (Hand sulks)TOILETS WATER PIPING DISHWASHE RAINWATE EMS U OTHER (D be) DRAINS SHO V UM BREAKERS DRI. G FOUNTAINS {Mahon/Uwfty) ATER HEATERS (netric) H SE BIBBS t SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL MECHANICAL FIXTURES Value of Mechanical Work $ WATER PURVEYOR OF BID OR EST&MM MUST BE PROVIDED) Indicate number of each type of furture to be or relocated as part of this project. Do not tncWde115astingftvtures to remain. AIR HANDLING UNITS ANS GAS PIPE OUTL OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS) BOILERS FURNACES ATER TANKS (Gas) COMP ORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING FIXTURES Indicate number of each type of jbcftwe to be installed or reloc as part of this project. Do qot include existing fixtures to remain. BATHTUBS (or Tb -r Combo) LAVS (Hand sulks)TOILETS WATER PIPING DISHWASHE RAINWATE EMS U OTHER (D be) DRAINS SHO V UM BREAKERS DRI. G FOUNTAINS {Mahon/Uwfty) ATER HEATERS (netric) H SE BIBBS t SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF FMSTMG DWROVEMENTS Additional Information NEW Bu"ING ....... ......... _.... FIRST FLOOR (or Mobile Home) zxunmtG/MUM01J8 USE LOT SIZE (In Square Feet) EXISTING FIRE SPRIlH6 "SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? OYes ❑ No e Yes o No RESIDENTIAL AREA DESCRIPTION (in square feet) MaSTING PROPOSED TOTAL FOR OFFICE IXE __......... .___..._.__._._..__._._......._.._.._._._. BASEMENT Additional Information NEW Bu"ING ....... ......... _.... FIRST FLOOR (or Mobile Home) SECOND FLOOR .............. _.._......__._.__..... ............. ...... ..._.._. COVERED ENTRY COMMERCIAL - REMODEL/TENANT IMPROVEMENTS .... _.... _._............... _._... DECK Area in Square Feet Occupancy Group(s) Construction GARAGE ❑ CARPORT ❑ Additional Information TOTAL BUnam OTHER (describe) .............._._..._.... _.._............ _........._._...._..._... Area Totals sada' M PROPS TOTAL __..._._...._..._........_.._...._.._..._....... ._.._........ ••NEW HOMES ONLY" ESTIMATED SELbWG PRICE $ COMMERCIAL - NEW/ADDITION AREA DESCRB'TION Area in Square Feet Occupancy Group(s) Construction # of Stories Additional Information NEW Bu"ING ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction # of Stories Additional Information TOTAL BUnam TEN NT AREA ONLY PgojEcr AREA ONLY Bulletin #100 - 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application