18-103820`
PERMIT APPLICATION
CITY Of
Federal Way PERMIT CENTER + 33325 81h Avenue Soutl>g^!Iee 003-6325
253-835-2607 + FAX 253-835-2609 + permitcen el .O dy.com
® AUG 2 1 2018
PERMIT NUMBER C-1 TY OF FEDERAL WAY
— TARGET DATE
SITE ADDRESS
SSD S®- 320
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOWSTAX/PARCEL @
'
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING OOM PREVENTION
NAME OF PROJECT
C Ve - G C g=
PROJECT DESCRIPTION
Detailed description
L
C, � '3
AC_ (si ^3
of work to
be included on this permit only
NAME
PRIMARY PRONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL,
CITY
STATE
ZIP
NAME
5 � ��b1��
PHONE
-317-
MAILING ADDRESS
30/` ,
E-MAIL
K® ✓I S c'1
CONTRACTOR
CITYSTATE
rt.
✓-e-c—
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE 8
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE @
5L�pC
®I
G,
0-14-ru-
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N ME
-97-0c.-
PRIMARY JPHONE
�
MAILING ADDRESS
Akqy;f—
E.MAH,
APPLICANT
ez
WimZIP
+`y
FAX
PROJECT CONTACT
NAME
iS e" - W j, C� V l a r1
PRIMARY PHONE
`a2 - 3) -7-
MAILING ADDRESS
3011-1 d
MAD,
Oise,., CA[ Sec Co tit
(The individual to receive and
respond to all correspondence
CITY
STA
ZIP
concerning this application)
9AX -31 -
PROJECT FINANCING
NAS
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❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27 0951
MAILING ADDRESS, CITY, STATE, ZIP
1 g y � : K •CJ �1/ �•• � = "'C.�C C•�
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I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certgy 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 perm, 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
Wormation suppli to the city ay a part of this application.
o �y
SIGNATURE: v(/d� DATE
PRINT NAME:
Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Iandouts\Permit Application
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MECHANICAL PERMIT LUE OF MECHANICAL WORK
Indicate how marku of each tum qf firbi— to be installed or relocated as part of this project. Do not include existingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (caa)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
EXISTING/PREVIOUS USE
LOT SIZE IIa Square Feet)
EXISTING FIRE 8PIUN]UXR SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include exist'
fixtures to remain.
BATHTUBS (or I)A/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 (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIKTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF Effi8TING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE IIa Square Feet)
EXISTING FIRE 8PIUN]UXR SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Pennit Application