12-105290 / a - / 05a90
RMF CO ME PL DE EN FP
i Federal Way REGI" " �
COMMUNITY, DEVyEf('LO:PMENT SERVICES
AF P LT VV T T 0
N
253-835-2607•FAX 253-835-2609
l,,!.r; ff ) U^!!);(tf.OM MN 21U1
SITE ADDRESS CITY OF FEDERAL WAY
CDS
SUITE/ IT#
\ \ 0 0\ b v-Ab Sf lir
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
`-\ COa(Ia moo? / 6V - 7o670)--,
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ ECHANICAL
❑ DEMOLITION 0 ENGINEERING .LRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) Dc C1Ac 1� oo\1C `
PROJECT DESCRIPTION �5�� � 1�� O`'e �� l `��� �� �'�r�
Detailed description of work to C: i\� `( SN )-e0 �0\1 -_
f
be included on this permit only
��'� V� \ c j Q c�G
'e3ACA
NAME (` 1 PRIMARY PHONE
PROPERTY OWNER f�cb ( U (Q �,F 1\\��, L.UC /
MAILI P i" %),N E-MAIL
a / \ U1/4)J4 V q (S 0('` ITE�1"
TQ �
NAME .V\b\A\CN‘Nc\/ 'T(AVIN Pc9 E -6... L1 G---)
_ -
MAII,LpLG*DA ESS �� C. /1 r ��(E-MAIL M/ 11a 1,�)
CONTRACTOR \ (�J{J ' vvV1(0(-J''�J�`\\�f-!\Zcji-o`woNJJ" (oc
CITY STATE FAX , "v`v r
WA ATE�ONTRACTO���1T �.(\� � ��7CP�BION��� FEDERAL WAY BUSINESS LICENSE#
NAME VO'\\\4\ {V PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACTci,),...a
NAM PHONE 2�-�- -36---3
--�-
(The individual to receive and
11 rfix.„ �S3respond to all correspondence MAILING ADDRESSE-MAIL
concerning this application)
CITY STATE ZIP FAX
ALTERNATE CONTACT NAME: PHONE E-MAIL
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 ant 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 ha ss thlCity of Federal Way as to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense o such lr-im), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim a es o of the reliance of the city, including its officers and employees, port t e accuracy of the
information supplied to the cit as a a,t of is application.
illSIGNATURE: (144 14 DATE
1
PRINT NAME: / ,- `\ Ci\,1, ( b9f(01\`
Bulletin#100—January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
• 111
1 E CflANIC: 1: IXT RES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
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(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST zr
DUCTING GAS PIPING WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not inclu. existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKER
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATER Electric)
HOSE BIBBS SUMPS WASHING MA 'INES TOTAL FIXTURES
GENERAL IaF{)I 'IA`TIO v
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR \ SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Fee EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
q 'es 1:1 No ❑ Yes ❑ No
f/
FSmEN' 4 E OR D'PITIO
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile[(bind
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT C
OTHER(describe}
EXISTING PROPOSED TOTAL
Area Totals
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS_
,C)ti.I: i RC;L VL 3 1 EW/A DI T IO'+
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
4r" w. Nitaftv
ADDITION
Co MMYMERc AL RE tolik-/T NANt IIIPROVFMFN S
AREA DESCRIPTION Area Occupancy Group(s) Construction of
Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT \ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2011 Page 2 of 3 k:\Handouts\Permit Application