18-102527RECEIVED
11111;k PERMIT APPLICATION
CITY OF CITY OF I Way JUN 11 2018 PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentelfacitvoffederalwaY.com
C17Y OF FEDERAL WAy
COM UNfTY DEVELOPMENT
PERMIT NUMBER )( _ 1 -6 � �� / I _ {.� J*/
I TARGET DATE
SITE ADDRESS
SUITE/UNIT #
c;25b 5 S
PROJECT VALUATION
(7b�
ZONING
Cc, C
ASSESSOR'S TAX/PARCEL
19—
9—
TYPE
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING I FIRE PREVENTION
NAME OF PROJECT
1C
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAMEPRIMARY
PHONE
CCo - r,
PROPERTY OWNER
MAILING ADDR S 4, %
MAIL
CITY
STATE
ZIP
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NA
LLC
PRIMARY PHONE
MAILING ADDRESS
635oRLkXA o
E-MAIL
APPLICANT
I
STATE
ZIP
W
F
--� -_-
NAME ,
PRIMARY PHONE -_-
PROJECT CONTACT
M I O
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or Ill ore
(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 irkformation 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 t the city as a part of this application.
I p
SIGNATURE:71;DATE
PRINT NAME: �� 1
IIul letin # 100 —January 29, 2016 Page 1 of 2 k:AHandoutsTermit Application
low
MECHANICAL PERMIT
Indicate how many of each typ
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
PLUMBING PERMIT
Indicate how many of each type
BATHTUBS (or Tub/show c=bo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
to be installed or relocated as
FANS _
FIREPLACE INSERTS _
FURNACES _
GAS LOG SETS —
GAS PIPING
to be installed or relocated as
LAVS (Hand Sinks( —
RAINWATER SYSTEMS _
SHOWERS —
SINKS (Kacb_/utility) —
SUMPS
VALUE OF MECHANICAL WORK
f this project. Do not include
GAS PIPE OUTLETS _
HOODS (comme e.4
HOT WATER TANKS
REFRIGERATION SYST
WOODSTOVES
TOILETS
URINALS
VACUUM BREAKERS
WATER HEATERS (EtKtnq
WASHING MACHINES
g fixtures to remain.
OTHER (Describe)
VALUE OF PLUMBING WORK
dude existing fixtures to remain.
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
Su (T -f- ala
fxks-rtgj r..
f'u►STIf�lC_
$
EXISTING/ PREVIOUS USE
O-wlce
LOT SIZE (In Squ— Feet(
6b mo „t.
EXISTING FIRE SPRINKLER SYSTEM?
)(Yes No
PROPOSED FIRE SUPPRESSION SYSTEM?
Yes No
RESIDENTIAL -NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
Additional Information
NEW BUILDING
FIRST FLOOR (or Mobile Home)
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
SECOND FLOOR
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
COVERED ENTRY
DECK
TENANT AREA ONLY
GARAGE ❑ CARPORT ❑
PROJECT AREA ONLY
OTHER (describe)
Area Totals
EXISTING
PROPOSED
TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area is
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TUTAI, BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin # 100 - January 29, 2016 Page 2 of 2 k: liandouts\Permit Application