11-101742ARECEI'V L
CITY (W Federal Way MAY, 0 6 20i1PERMIT
COSERVICES
253-835-2607- FAX 253-835-260AfPILICATIONVVFU
wull'xituoO
F FEDE
CDS
_L _ - _f G f 2--�-C;_1
SF MF CO ME PL DE EN 0
p ri l
SITE ADDRESS
SUITE/UNIT #
37-123 1%,h L4j. s,LJ,
F&Da"t—LAO Yj w,4 980Z3
jku,. l5 -
PROJECT VALUATION
a
ZONING
ASSESSOR'S TAX/PARCEL#
$ ) D, ooa•
R- Z
1 3 7-
1 D 3- 9 1 C
TYPE OF PERNUT
❑ BUILDING ❑ PLUMBING
❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING
PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name))US
L %
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
1 ILE W ARS 1 aw e-
Z5 -'3 -838 -"-?7
MAILING ADDRESS
E -MAD.
CITY
fADMAL LSA
STATE
wA
ZIP
9,8023
N_
,45'i 0A1E JAje_
PHONE
26&-5-75 =031)
MAILING ADDRESS
Di r1 Fjj,)er0A) QLvD.
E -MAD,
ro"sQ Lm OAX.04.7
CONTRACTOR
CITY STATE
ALL,o A WA_
ZIP
9�4Q I
FAX
257-735-147761
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
1 r.D17*o 1<w
5 i i� i 12
NAME
PHONE
Fi IZEaNE NC.
206-675--0311
MAILING ADDRESS
D 7 &LASH AAr(;) BLVD.rL90_F1Qr&
E-MAIL
026,
APPLICANT
CITY
ALL,oAJA
STATE
ZIP
FAX
26-3 --13s =447(o
PROJECT CONTACT
NAME
%vow
PHONE
2o& -5 -7S -.a311
(7he individual to receive and
MAULING ADDRESS
4g
E-MAI.
respond to all correspondence
concerning this application)
O 0 GIJ
CITY
aA-
STATE
WA-
ZIP
98001
FAX
2S3 -73s= 14 4-7G
ALTERNATE CONTACT NAME: (�
PHONE
E-MAIL
PROJECT FINANCING
NAME
A I� 11
,V jam!
� 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 cert(fy that to the best
of my knowledge, the iriformation 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 6;4f'//
3/y
��f
/
PRINT NAME:
LT�OLLIG:
Bulletin #100 —January 1, 2011 Page 1 of 3 k:AHandouts\Permit Application
•
0 •
VALUE OFMECEIAMCAL WORK $
BATHTUBS (or Tub/shower combo)
(a copy of bid or estimate must be provided)
Indicate how many of each type offixture 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 (commereiaq
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
Indicate how many of each type offixture 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)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Unity)
WATER HEATERS (Ewnir)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
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?
Z, ❑ Yes 'Y No ❑ Yes K No
AREA DESCRIPTION Area Occupancy Group(s) Construction # of Additional Information
in Square Feet Type Stories
NEW SoAMMG
ADDITION
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application