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14-106152tA CITY OF 'A APPROVS PERMIT AWCATION Federal Way DEC Q 2 2014 PERMIT NUMBER _ / �J � _ t.tU,T( fTf EDERAL WAY S� «< hi>z6B `S SITE ADDRESS j `� Q yam} /� hq t , ,�'%� j� 31aq:h -( ,4 SUITE/UNIT # PROJECT VALUATION �d 0 ZONING ASSESSOR'S TAX CEL # R a 6 q 1 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION NAME OF PROJECT �/1 Ll� � m � r— ReJ�O i'54ni i Te PROJECT DESCRIPTION Detailed description of work to(41 /���'1") 6% 04 d ec p5 �� f6r 5 b e be included on this permit only PROPERTY OWNER NAS � �� �7 (t//,�J r P 5' 1 C-- PRIMARY PHONE M ING ADD S D9 5. 33 0 5-Y E-MAIL c U4 S > Z� Ifoo 5 fieri t �cr► eGecr/ z 3 -63g- I?q 9 ING ADD SS d` �x -?177 CONTRACTOR CITY ( STATE ,vl`v("'I[,1.. ZI1 Vb - e� 7EXPIRATIION "1757-63E-0396"' 75 J 3 —D 39 [%S/`TA��T/'EY/C`IO•..,�T.RACTOR'S WLICENSE # DATE^ 15 FEDERAL WAY BUSINESS LICENSE # ,ZcC. �,-©6�-/oo�S{S�-CGb - 6 /�_2� � P0�7 ! ! C7`{'��✓6 L 1/`�CT1 /tr 7'TTV ( ING ADD S E- APPLICANT T Z SD -o,� A� 3-&3$-- 0 39 4 PROJECT CONTACT NAM re-, 5 PRIMARY PHONE aP,573-&J - I MAILING DDRESS-7/-7 . o - x I E-MAIL - Qg Myv e— (The individual to receive and respond to all correspondence ci STATE Wi4 ZI �$oL}-"�- FAX concerning this application) PROJECT FINANCING NAME 0 OWNER -FINANCED Required value of $5,000 or more (RCW 19.27.095) MAILING ADDRESS, CITY, STATE, ZIP PHONE 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 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: DATE ! / gl., 1 '-041 f PRINT NAME: Bulletin #100 — January 1, 2013 Page I of 3 k:\Handouts\Permit Application /'kk 0 • GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR VALUE OF MECHANICAL WORK MECHANICAL PERMIT EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) $ Indicate how many 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 OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (commere+aq OTHER (Describe) BOILERS FURNACES HOT WATER TANKS (Gas) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR VALUE OF PLUMBING WORK PLUMBING PERMIT EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? Indicate how many of each type offivture to be installed or relocated as part of this project. Don include existin fixtures to remain. BATHTUBS („r Tnb/shower Combo( LAVS Hand Sinks( TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS (Mtohen/Unity( WATER HEATERS (Eie,trd,( HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ❑ Yes ❑ No �:i Yes E: No Bulletin #100 — January 1, 2013 Page 2 of 3 k:\Handouts\Pennit Application