16-105218 NIIII. • PERMIIOAPPLICATION
CITY OF
Federal Way PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permit®rE pf}erbway.com
PERMIT NUMBER ( co _ 1 0 5 Z I e OCT 2 7 2016
— — TARGET DATE
CITY OF FEDERAL WAY
SITE ADDRESS
SUITE #
Zai ate )-ALL DA) WDE--12_k_ 1 JJ
PROJECT VALUATION ZONING ASSESSO TAX/PARC L# 9 - O f
9 z 4,
(c, e-.)
TYPE OF PERMIT $J BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT ( � 1-1h i- r1 1 iLJ I /____ C
PROJECT DESCRIPTION Dyaflir '�/
Detailed description of work to
be included on this permit only
•
NAME h n�l f PRRII�MAAR ECT Dl'i
�7 �J
PROPERTY OWNER ' o � P lax Pk,~ 1 1 Cl+vn �I OPV �j 1?j' / /
MAILING ADDRESS E-MAIL
a, aD 2- t A /0 a l some/lel llj Pythe'D,Com ,
CITY t.F�^-A V N/'``� ` SAI TATE ZIP q Z OA '
NAME
IV ,In.� l Ca Nla1.tC ION PHONE
MING//'�ADDRESS MAIL
CONTRACTOR l �l"f.W i S k I�L�(620 I1 I, iA1 A—3 a i� -E
CITY � ^1\1 STATE A ZIP 12 o FAX
WA STATE CONTRACTOR'S LICENSE# ,W1'�) EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
NAME ` , t t,4 no r //yy// P,RI Y/PIHONE
Ii?77 i
APPLICANT MAILING ADDRESS j (�S4C S--,E-MAILL "&fro f
CITY a I STATE ZIP (2:452,��f FAX
NAME VikiiY �W)'J`�- /V1 JL a PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
' respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 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 ci as a part of this application.
/�-
SIGNAT ��� 1 DATE o01 9"? /(
PRINT NAME: k \ 1,i
Bulletin#100–January 29,2016 Page 1 of 2 k:\l-landouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
$
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.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACES HOT WATER TANKS(cas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING 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.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) TOILETS WATER PIPING
MSTMAST-IF:RS RAINWATFR SYSTRMS TTRINAT.0 OTT-TFR(Tlcsrrihal
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATE't (Electric)
HOSE BIBBS SUMPS WASHING M: HINES TOTAL FIXTURES
GENER AI, INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIR' 'PRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
es ❑ No ❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROP•SED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
................................................................................................................................................................................................
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
•STING PROPOSED TOTAL
Area Totals
1.
**NEW HOMES •1VLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITI I,' _
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square F=-t Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODE /TENANT IMPROVEMENTS
AREA DESCRIPTION ea Construction # of
Occupancy Group(s) Additional Information
S. .are Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application