18-104247CITY OF
Federal Way
PP=M= NUMB=
9
PERMIT APPLICATION
PERMPr CENTER + 33325 8th Avenue South j 3-6325
253-835-2607 + FAX 253-835-2609 + permitei� t�e cow
f7p
SEP 12 2018
TARGET DATE _CITY -OF FEDERAL WAY
UEVELOPMEW
BITE ADDRESS
321 Z� 32-n°4
ALI-R- S
SiTm/UNIT #
7W4 F-tZ
PROJECT VALtTATIO$
$ � 70. �'M-'
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TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERINGRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed descaiptlon of work to
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be vecluded on this permit only
NAME
PRIMARY PRONE
PROPERTY OWNER
MAu NG ADDRESS
E-MAM
CITY
STATE
ZIP
NAM
41 PHONE mil
MAUJNG ADDRESS
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E-MAM
mt i n f3" ® Cv
CONTRACTOR
O
Gid
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F"W
WA STATE CONTRACTOR'S LICENSE #
Cc�NUETL9�{ (
ESPIRATION DATE
6
FEDERAL WAY M161NESS LICENSE #
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NAME
Ise- ver-�
PRIMARY PHONE
AL41L IG ADDPJM
WMAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
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PRIMARY PHONE
LI - S l -
MADdNG ADDRESSI .. II
".�RLkC AA'f—
E -MAD.
(The individual to receive and
respond to all correspondence
WTATE AS'
�g
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is $5, 000 or mare
(RCW 19 27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I cert{ fy under pens ty of perjury that I am the property owner or aathorlaed agent of the properly owner: I certvy that to the best
of my knowledge, the ingjbrmation submitted in support of this permit application is true and correct I certify that I will compbJ with
all applicable sty of Federal Way regulations pertaining to the work authorised by the issuance of a permit Z understand that the
issuance of this permit does not remove the owner's responsibility fbr compliance with Ioca4 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
irViwmation supplied to the city as apart of this application.
SIGNATURE:
DATE
�7
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PRINT NAME:
Enw
Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Handouts\Pcmut Application
f. r144
cCA'VN
01044 (
1 0
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how nuany of each type o re to be installed or relocated as art o this ro' ct. Do not include ezis ' res to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (com—cmi)
BOILERS FURNACES HOT WATER TANKS (cae)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
GENERAL INFORMATION
CRrnCAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OFPLUMMTNG WORK
PLUMBING PERMIT
7_5700. �
MUSTING/PREVIOUS USE
LOT SIZE (In Square Feet)
=STING FIIffi SPRINKLER SYSTEM
$
Indicate how Many o eache o
re to be installed or relocated as
art o this ro' ct Do not include .xis
' res to remain.
BATHTUBS (or Tub/shower Combo)
LAVS (Hand sink.)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/unary)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FEKTURES
GENERAL INFORMATION
CRrnCAL AREAS ON PROPERTY?
WATER PURVEYOR
8EWER PURVEYOR
VALUE OF EXISTING IDSPROV&MENTS
7_5700. �
MUSTING/PREVIOUS USE
LOT SIZE (In Square Feet)
=STING FIIffi SPRINKLER SYSTEM
PROPOSED FIRE SUPPRESSION SYSTEW
`SzvfYes ❑ No
ii Yes W No
COMMERCIAL - NEVADDITION
AREA DESCRIPTION Area in Aare Feet Occupancy Group(s) Construction TywStories Additional Information
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Bulletin #100 — January 29, 2016 Page 2 of 2 k.\Handouts\Permit Application