18-104965` RECEIVED
CITY OF � OCT 22 20ta PERMIT APPLICATION
Federal Way PERMIT CENTER + 33325 811,Avenue South + Federal Way, WA 98003-6325
CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER ` _ 1(9 5, _
TARGET DATE
SITE ADDRESS e v , j / ��I S
SUIT /UNIT #
PROJECT VALUATION
$ `26L,,o
ZONING
ASSESSOR'S TAR/PARCEL #
1 3 2 1 C 3- 9� 9
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING i1RE PREVENTION
NAME OF PROJECT
�(, C, a!oe-1— 20 ej
PROJECT DESCRIPTION
Detailed description of work to
�,
0 �/ h no
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME ^
Iii
PHONE
1, , 2 2
MAD.ING ADDRESS
E-MAIL
CONTRACTOR
S �C .�
CITY
{v -t
STA
ZIP
Fy-a ki j< So a r W
WAS SME LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT-
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
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 more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.2 7.095)
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 information 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 of this application.
SIGNATURE: ��� DATE e
PRINT NAME: i-G�t ii L
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\HandoutsTermit Application
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Ym�
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
S R PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
f, •b"-' „1, `. : • ti, "•. d ,.`.;.y £f. ,,..,-,:f %,.,
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
EXISTING/PREVIOUS USE
LOT SIZE )Ia Square Feet)
$
Indicate how many of each type offxture
to be installed or relocated as
part of this project. Dont include existing res to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commercial)
BOILERS
FURNACES
HOT WATER ANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGE TION SYST
ESTIMATED SELLING PRICE $
DUCTING
GAS PIPING
WOOD OVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each type offixture
to be installed or relocated as
pa of this Project. Do not include existing res 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/Utility)
WATER HEATERS (Electric)
HOSE BIBBS
STUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
S R PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
f, •b"-' „1, `. : • ti, "•. d ,.`.;.y £f. ,,..,-,:f %,.,
FIRST FLOOR (or Mobile Home)
EXISTING/PREVIOUS USE
LOT SIZE )Ia Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
COVERED ENTRY
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXIST G PROPOSED TOTAL
FOR OFFICE USE
r 7 i
_.-..__'---------- ------....... —................. __..............
f, •b"-' „1, `. : • ti, "•. d ,.`.;.y £f. ,,..,-,:f %,.,
FIRST FLOOR (or Mobile Home)
is'•uf.•.w' 'Ai`-' .n'Y .'.1??'4,y ,#!of.�Y }#;4b,4 `
COVERED ENTRY
$£ u
T>
BE US-
GARAGE ❑ CARPORT ❑
'.Y.At
Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ DITION
Area is Construction # of
AREA DESCRIPTION Occupancy p(s) Additional Information
/Square Feet a Stories
M���f maim
__- ADDITION _..
COMMERCIAL MODEL/TENANT IMPROVEMENTS
AREA DESCRIPT N Area in Construction # of
Occupancy Group s} Additional Information
,.- .. Square Feet ,,..-,,,', ���, � Type Stories.
TENANT AREA ONLY
Bulletin #100 January 29, 2016 Page 2 of 2
k:\Handouts\Pelmit Application