12-105372ECEIVED PERMIT
Federal
eoMref nYllcEr r�lEhrsl e s 2 g 201 APPLICATION
�fi3-b"35�'rG07• FAX 253Si'S
CITY OF FEDERAL WAX /dl fQ] FD�DnU7Fn)
4Z" 10 72 ---
SF MF CO ME PL DE EN FP
SITE ADDREli6TENMT
#
iLDV Som+ 3zyT" 9-7- r --r-, FE0Z.&* .w41IwA gKoo3
PROM=VALDATION
ZONING
ASSESSOR'STASfPMWEL#
$ 35401 - 50
/ 5 0 0 5 0- 0 0 S 0
TYPE OF PERMIT
❑ BUIIAING ❑ PLUNUM IG ❑ MECHANICAL
0 DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PRQTECT
(Tenant NarwIllomeowner Last Norm)
�j
!V FC), l t A 2-14-
itMCPLA�Msk ` cS F f:ArLLA;'J" F/per— 6wrm&� t n►£c
PROJECT DESCRIPTION
Detailed description of uxu* to
ie eC � J $� +��� �w�llwtoltCG R7+F✓YArt L
be induded on this pernlrt only
NAME PRIMARY PHONE
PROPERTY OWNER
4, le-&) FVa Kk Z,53 -7q2 ---3i'5(
irAD�G AD7>$ESB
WMAD.
MYSTATE ZIP
ArroercAt- t.✓ TA- q8'V .S
MORE
rc� dam- 14-
PHONE
zoc, S7S�a srl
MAELINGAD>NUffi
10-7 W,+$WNAlGrTbN r3"D
F MAD.
WA4U U IN -Er '
CONTRACTOR
MY
A-t4lor'JA
STATE
I wP-
ZIP
18100/
FAX
23-755- q
WA STATE CONTRACTOR°$ LCENSE #
r1"01 A09gKw
EXPIRATION DATE
s J /Qi / 13
FEDERAL WAY BUSINESS LICENSE #
NAME
PHONE
SAYMIr As CooUTAAtmt-
APPLICANT
19AUMG ADDIMSO
E MAD.
CITY
STATE
ZIP
FAX
PROJECT CONTACT
rHw tnd Lvidual to receive and
respond to all correspondence
concerning this apptkcaiior0
HAMM
r M �ASTMfr7Y
PHONE
Ztl 1p -cerci ...ZZS 7
IwDgG ADnttaSS
10 7 &,VASJ41 A141U i UJD
s VIAM
hCTo
CITY
Ift-60,v&
STATE
I wA-
ZIP
ggoo/
FAX
253--735-,tq7
ALTERNATE CONTACT A&DIR:
PHONE
N -MAD.
PROJECT FINANCING
NAS
OWNER -FINANCED
Required value of $5.000 or more
(RCW 19-27.095)
MAH2NGADDEXS8. Cr T. STATE. ZD•
PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certTy that to the best
of mg knowledge, the iriformation submitted in support qr this permit application is true and correct. I certify that I will comply with
all applicable City of FederalWay !!!!lana pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not renwoe a owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the of Ft'deral Way as to any ctaim !including costs, expenses, and attorneys' fees incurred in
the investigation and defense of which may be made by any person, including the undersigned, and fitted against the city,
but only where such clair f he reliance of the city, including its officers and employees, upon the accuracy of the
information supplied i%rt rt is di
i'
SIGNATURE- t DATE
PRINT NAME' % �Ad
Bulletin #1(X) - January 1, 2011 Page 1 of 3 UllandoutsWermit Application
M
9-L
V
,219-73
16 0
GENERAL INFO R ION
MECHANICAt, FIXTURES
VAUM OF MECHANICAL Wogs $
SEWER PURVEYOR
(a—copy o- bid or estimate must be provided)
Indicate hour many of each. type of jlxtllre to be installed or r
as")tai 4j_ this project Iia not include existing fixtwes to remain
AIR HANDLING UNITS
FANS
GAS PIPE OUT'LET'S OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERT'S
HOODS fcnmmerciat)
BOILERS
FURNACES
HOT WATER TANKS ;Ga )
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
GENERAL INFO R ION
CRITICAL. AREAS ON PROPERTY?
PLUMBING FiXTURES
SEWER PURVEYOR
Indicate hose many of each type of fixture to be instnlled or relocated as part of this project. 1?o not Include
extstMg jixtiLres to remain.
TOTAL
BATHTUBS t-Tub/sh.—c—bw
LAVS le—dst k.1 TOILETS
WATER PIPING
LOT SLZE in SQA Fat)
DISHWASHERS
RAINWATER SYSTEMS URINALS
OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
SECOND FLOOR
DRINKING FOUNTAINS
SINKS (tcu�h-lutraty) WATER HEATERS (E[ ant )
AREA DESCRDPTION
Area
in Square Feet
HOSE BIBBS
SUMPS WASHING MACHINES
TOTAL FIXTURES
GENERAL INFO R ION
CRITICAL. AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EffiSTING IID'ROVEBMTS
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
ESISTRW/PREVIOUS USE
LOT SLZE in SQA Fat)
FMSTMC. FIRE SPRDUKLER SYSTEX9
PROPOSED FIRE SUPPRESSION SYSTEM?
FIRST FLOOR (or Mobile Home)
Yes - No
v Yes J No
ESI E--NTIAL
m Nu.w (. -RADDITION
Area arra Feet
in SqNEw
AREA DESCRIPTION (in square feet)
EIEWING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COMMERCIAL -- REMODEUTENANT I 'II RO I -MI=
N`I S
AREA DESCRDPTION
Area
in Square Feet
COVERED ENTRY
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
DECK
GARAGE ❑ CARPORT ❑
OTHER (deserlbe)
PROJECT AREA ONLY
Area Totals
TOTAL
"AlEW HOMES OIKLY**
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL --E'VNI DDITIO
AREA DESCRIPTION
Area arra Feet
in SqNEw
Occupancy Group(s)
Construction TypeSt
oOfes
Additional Information
BumDING
ADDITION
COMMERCIAL -- REMODEUTENANT I 'II RO I -MI=
N`I S
AREA DESCRDPTION
Area
in Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - January 1, 2011 Page 2 of 3 k:Ulandout%\Permit Application
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