15-106304 RECEII► •
CITY p# DEC 14 2015 PERMIT APPLICATION
Federal Way_
OF FEDERAL WAY
CDS /''�
PERMIT NUMBER / S _ / 0 '� O y_ Y p
TARGET DATE
SITE ADDRESSSUITE/UNIT#
39.„5-0 S'd3YJc 4r)4- �51��/7/3_ "
/-c-de,-4/ l / �/� 62e9d%PARCEL#
PROJECT VALUATION I./ZONING ASSESSOR'S9TAX/PARCEL
$ 4, 6.-7 7Z z Z. 1 a 4 - 1 a 4 o
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 4 FIRE PREVENTION
NAME OF PROJECT —rES pZ T
PROJECT DESCRIPTION ADD * �c-�-1' SP>zt���V-S w `
Detailed description of work to L-0LA-TLpi.\J.
be included on this permit only
PROPERTY OWNER NAME PRIMARY PHONE
f-\I PrN‘ I l a 4-4 f' 6/
MAIIdNK6-ADDRESS )t))( E-MAIL
CITY /` 4-1
STATE ZIP
at .S6 CA g2-0LB
NAME
✓4-1�euczt--ur, N 4 PHONE
'��
MAILING ADDRESS E-MAIL
CONTRACTOR b5-S- 5o �Co
CITY STATE ZIP ^ 3 FAX
WA STATE CONTRACTOR'S LICENSE# /V,KIL�'- EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
AV-C-4cl Z1 l iZ 31 / 15
NAME PRIMARY PHONE
3C-6etEsigastr—
APPLICANT MAILING ADDRESS E-MAIL
L
CITY STATE ZIP FAX
PROJECT CONTACT NAME W ��t S PRIMARY PHONE
(The individual to receive and MAILING ADDRESS EMAIL
respond to all correspondence ✓F"v��
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
Required value of$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 city as a part of this application.
`
SIGNATURE: DATE Z - I0 - 5
PRINT NAME: Sir 1 Beal-
Bulletin
erBulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Permit Application
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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 FANSGAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial)
BOILERS FURNACESHOT WATER TANKS(sae)
COMPRESSORS GAS LOG SETSREFRIGERATION SYST
-
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING 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.
BATHTUBS(or Tub/shower Combo) LAVS(Hand sinks) -
TOILETSWATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALSOTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) WATER HEATERS(Electric)
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 ❑Yes 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home) _._._..__ _._.--.-•---
SECOND FLOOR
COVERED ENTRY
--
GARAGE ❑ CARPORT 0
OTHER(describe)
EXISTING PROPOSED TOTAL
Area Totals
4**NEW HOMES ONLr ,
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AreaConstruction #of Additional Information
AREA DESCRIPTION Occupancy Group(s) a Stories
in Square Feet �P
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area Occupancy Group(s) Construction Stories Additional Information
AREA DESCRIPTION is Square Feet
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application