13-104679DECEIVED 40
clrf OF PERMIT AP'P'LICATION
Federal Way OCT 2 2 2013
CITY OF FEDERAL WAY
PERMIT NUMBER 3 _ / /, S _
_! TARGET DATE
► 3 3
SUITE/UNIT #
PSITEDRESS
_►
JECT VALUATION ::::[7�E:1Gl31,1LD11NNG
5��1�3
IN
ASSESSOR'S T/PEL #
0��U--�ZY
TYPE OF PERMIT
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❑ PLU�IBIVG ❑ bl�cH.wic.4t ❑ D��ioun��rr ❑ Er;ai�;���1>rU FIRE PReaevrro�r
NAME OF PROJECT
S I L'
PROJECT DESCRIPTION
� y� 5,o + 5 +9 r �'�� �" ��
Detailed description of Lvork to
be included on this permit only
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PROPERTY OWNER
NAME
Tfi"q//t jrA/f r� /yc
PRIMARY PHONE
LS)v 3� -3
I�
MAIL�ING ADDRESS �
E•3iAIL
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V v
ZIP
ME
lKAILING
PHONE
ADDRESS
12
F ;MAUL
CONTRACTOR
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C��`�;`#" ST. E TiZi." V i
2 '�' �. D- Sr5 1 LPi YYi
1
WA STATE ONTRACTOR'S LICENSE # _
-r
EXPIRATION DATE
4 13 0/4
FEDERAL WAY BUSINESS LICENSE #
NAME
��_rl i I?W
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
Nr&f
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PRIMARY PHONE ff
l D t -7ta-7 D X I
PROJECT CONTACT
(The individual to receive and
I11,I7LING ADDRESS
_
V /— I ' 1
E-MAIL
respond to all correspondence
concerning this application)
CIT
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F
j
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PROJECT FINANCING
NAME
' A
� OWNER -FINANCED
Required value of $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
IRCW 19.27.095)
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 apart of this application.
P All y�is�J�
SIGNATURE: — DATE
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PRINT NAME:
Bulletin #100 -Jan Uary 1, 2013 Page I of 3k:\ ndouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
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 (commercial
BOILERS FURNACES HOT WATER TANKS (Gas
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
# of
Additional Information
$
Indicate how many 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 Combo(
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electrie
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Additional Information
in Square Feet
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
€ , �, ,,;r ;„�:
/Yes ❑ No
❑ Yes ❑ No
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
Occupancy Groups)
Construction
# of
Additional Information
in Square Feet
a
Stories
€ , �, ,,;r ;„�:
NEW BUILDING
$
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
IOccupancy Groups)
Construction
I
# of
Additional Information
in Square Feet
I
Type
Stories
TENANT AREA ONLY
Bulletin #100 —January 1, 2013 Page 2 of 3 k:\Handouts\Permit Application