18-103903WVOF PERMIT APP ON
Federal Way
l AUG 2 3 2018
PERNaT NII11�ER _ — TARGET DATE CfTY OF FEDERAL WAY
SITE ADDRESS
SUM/DNIT #
3-,1.20 i, 3 3 (.va 2+ e $�✓,-�d-Q-,�-� w�
'q Bldcy�
PROJECT VAIXATION
ZONING
ASSESSOR'S TAR/PARCEL #
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING HIRE PREVENTION
NAME OF PROJECT
Fe d e m l W S,t Iic Stmwn c -
F ► r( S pri r' KW✓ -j 10 0
PROJECT DESCRIPTION
Detailed description of work to
IN C+- A -V -,A _ b� a r auvS 4AIC-1- -
be included on this permit only
PROPERTY OWNER
C H R14 A W �j 1 S r `Pi
PHONE
SIV I A
n331x20 atSt SW
N/A
crry fed W
way
ZP�OZ
NIS
NAS N or wa.5r Fire S ISS
PHONE
11a-T50D,
MAII.IIpLi to 'j
a to 45 3rd Ave . S. Fal !�
✓ eo-rz nwFre5 5
CONTRACTOR
cm
V, &+,,,1--
; �
4 0 z
9a
aalo 3-6oq
WA STATE CONTRACTOR'S LICENSE #
►�ib�a-t-t �i2.�c.2
EXPIRATION DATE
oX/ ao 1;.o
FEDERAL WAY BUSINESS LICENSE #
do 1� ln� �t��• ��
NAME
NOr� �,t�lesr Fire S C
PKMIARY PHONE
5a�
APPLICANT
21AII'm° ADDRESS
a, o� S3rtLL Ave., S. QA %
E f �'r
Korea�nu ire s1 5
K C*1A-erry
, STATE
his o 3a
FAX
<M). - -T5 0
PROJECT CONTACT
NAM K }� �� K�� ►° �� NdYFP.t.•oc/ ore S;l0to
PRIMARY PHONE
'1-i a llsDg.
a ° � s i)
rJ
KAM
Ir I(�Gt.(Ici
I .
nI S
(The individual to receive and
respond to all correspondence
7QMH
w
zpm,Ij'
Fahy
concerning this application)
PROJECT FINANCING
NAM
❑ OWNER -FINANCED
Required value of $5,000 or more
NummO ADDRESS, CITY, STATE, ZIP
PRONE
WCW 19.27.095)
I cert(& under penalty of perjury that Z am the property owner or authorised agent of the property owner. I cert(fy that to the Lest
of my knowledge, the injbrmation submitted in support of this permit application is true and correct. I cert{fy that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised 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 fto then agree to hold harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and dgfense 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
injbrmation supplied tothecity as apart of this application.
4/\� tywy b\Y' 4fI/4 U aD Z 2:J • ri01 G0
SIGNATURE: DATE
R y -t 5�%S I GrwS
PRINT NAME: ketyk O'KeAf- 43 rkU( Ut%-
Bulletin #100 - January 1, 2013 Page 1 of 3 kMiandoutsWermit Application
Jr✓l
r
tY
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how of each type offirture to be installed or relocated as part of this prgjact Do not include existingjktures to remain.
AIR HANDLI14G UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
_ AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS. FURNACES HOT WATER TANKS (am)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?WATER
PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
NIP(
L&v_`
PPA
FIRST FLOOR (or Mobile Home)
$
EXISTING/PREVIOUS USE
Indicate how moy—my of each type of fbdure
to be installed or relocated as
part of this project, Do not include exis
' res to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Hand Smlm)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
OTHER (describe)
DRINKING FOUNTAINS
SINKS ()iteh./Uti7iry)
WATER HEATERS (Electric)
s�srmo
Area Totals
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FENTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?WATER
PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING EM PROVEAKENTS
NIP(
L&v_`
PPA
FIRST FLOOR (or Mobile Home)
EXISTING/PREVIOUS USE
LOT SIZE (In Sgmre Feet(
EMSTING FIRE SPRIiELER SYSTEMP
PROPOSED FIRE SUPPRESSION BYSTSM?
No
N lA
N1/A(
❑ Yes No
5 p�►h�_❑
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) MUSTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
i p 1�,t (moi
FIRST FLOOR (or Mobile Home)
SECONDFLOOR
AREA DESCRIPTION
Area
is Square Feet
Occupancy Group(*)
COVERED ENTRY
# of
Stories
Additional Information
TOTAL BUILDING
DECK
GARAGE ❑ CARPORT ❑
TENANT AREA ONLY
OTHER (describe)
PROJECT AREA ONLY
s�srmo
Area Totals
raoro®
rareL
**AWWMOMMS ONLY"
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIA — NEW ADDITION
AREA DESCRIPTION Area Aare Feet Occupancy Group(s)
in SqNaW
Construction TypeSt
of
Additional Information
BUQ DIBG 1(P 4, 0 b'?ji=45 7- 13
i p 1�,t (moi
ADDITION N IK
COMMERCIAL - REMODEUTENANT IMPROVEMENTS
AREA DESCRIPTION
Area
is Square Feet
Occupancy Group(*)
Construction
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 -January 1, 2013
Page 2 of 3
kAHandouts\Permit Application