11-101744Ak
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CITY Oi �{ LCE1
ly
Federal Way ` MIT
COMMUM7Y DEVEIA 253-8 SERVICES MA PLI CATI O N
253-835-2607• FAX 253-835-2609
imw cituoRederrdwau mm
rtTY ()F FEDERAL WAY
--I V L l l
"'
SF MF CO ME PL DE EN FP I
SITE ADDRESS
SUITE/UNIT #
3z12e- 20 fh R.A. 5. w, F#b&aAL-kWA) Y, WA 98xU
iku ,. 13
PROJECT VALUATION
$ °C
ZONING
ASSESSOR'S TAX/PARCEL #
)Q,a0o.
R-7
1 3 Z
TYPE OF PERAUT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeoumer Last Name)
S r ROi
DESCRIPTION
)USPROJECT �' T
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
1'-1kW ARl I f&i L
PRIMARY PHONE
MAILDVG ADDRESS
I 10 1 91 w. 32�+h
E -7x
CITY
&DAML WA
STATE
ZIP
23
NAME
Fi on1F IIV�.
Zai -5"7S-®311
CONTRACTOR
MAHJNG ADDRESS
167 u4 M/J1J&r0A) L611).
EMAIL
N&L5 (Qri2r&noA)e. o F&?
CITY
A STATE
a
ZIP
9 VGL 1
FAX
2SY —735 -q
WA STATE CONTRACTOR'S LICENSE #
F<W
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
`Oo
NAME
rl R ONE NC•
PHONE
2a(o-S 7 -03 I
APPLICANT
MAILING ADDRESS __ ll Q AMS If A47 -(;A) OLV
xLgc- IRx. -4wft. 026,
CITY
A Pjj4
STATE
14
ZIP
qS601
FAX
'26 -3 -WT -q'774
PROJECT CONTACT
(lite individual to receive and
NAME
EYRN w S
PHONE
20&-5-75--0311
respond to all correspondence
concerning this application)119-1GJ14$
MAILING ADDRESS r�
O� P L v 17.
EMAIL
��Y FI jL�-O �/(t. 004
CITY
n►tC.o�vi�
WSTATE
ZIP 98001
253-739= 9'76
ALTERNATE CONTACT NAME:
PHONE
EMAIL
PROJECT FINANCING
NAS
kt/ApQ
t
OWNER-FINANCEDTo
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS. CITY. STATE, ZIP
PHONE
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 irtformation 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 partof this application.
/�►
SIGNATURE.
PRINT NAME:/ boor
-- .-.I--, ...... rage 1 ors kAHandoutsTermit Application
VALUE OF MECHAMCAL WORK
Indicate how many of each type off
AIR HANDLING UNITS _
AIR CONDITIONER _
_ BOILERS _
COMPRESSORS _
DUCTING
Indicate how many of each typi
BATHTUBS (or7Lb/Shower combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
(a copy of bid or estimate must be provided)
to be installed or relocated as part of this project Do not include existing fixtures to remain.
FANS GAS PIPE OUTLETS OTHER (Describe)
FIREPLACE INSERTS HOODS (commerciaD
FURNACES HOT WATER TANKS Pas)
GAS LOG SETS REFRIGERATION SYST
GAS PIPING WOODSTOVES
to be installed or relocated as part of this project Do not include existing fixtures to remain.
LAVS (Hand Sinks)
TOILETS WATER PIPING
RAINWATER SYSTEMS
URINALS OTHER (Describe)
SHOWERS
VACUUM BREAKERS
SINKS (Ritchcn/utility)
WATER HEATERS (E)ectric)
SUMPS
WASHING MACHINES TOTAL FIXTURES
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR
EXISTING/PEE
RVIOUS USE LOT SIZE (In Square Feet)
7
F V
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
$A$EMENT
FIRST FLOOR (or Mobile Home) OO C
COVERED ENTRY
GARAGE ❑ CARPORT ❑
Area Totals
# OF
FOR OFFICE USE
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application