16-10217640k
WE'E' PERM' APPLICATION
CITY OF
Federal Way MAY 0 5 2016
r CITY OF FWER(AL WAY
PERMIT NUMBER („ _ o Coors
TARGET DATE
SITE ADDRESS
SUITE/UNIT M
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PROJECT` ,ON
$
ZONING
ASSESSOR'S T PARCEL i
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
NAME
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PRIMARY PHONE
vim•
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PROPERTY OWNER
MAILING ADDRESS
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E-MAIL
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CITY
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STATE
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NAME 4
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MAILING ADDRESS
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E-MAIL
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CONTRACTOR
CITY
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FAR
WA STATE CONTRACTOR'S LICENSE X
EEESLIONDATE
FEDERAL WAY BUSINESS LICENSE k
NAME
PRIMARY PHONE
MAu nvG ADDREss
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E-MAIL
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APPLICANT
CITY
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STATE
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-to
FAX CO
NAME
PRIMARY PHONE
PROJECT CONTACT
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
C!�175
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 19.27.095)
1 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 apart of this application.
SIGNATURE:! DATE
PRINT NAME:
Bulletin #100 — February 22, 2016 Page I of 2 k:\Handouts\Permit Application
A
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE Ila Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
Indicate how man of each type offtxture
to be installed or relocated as
part of this project. Do not include existing res to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commercial)
OTHER (Describe)
BOILERS
FURNACES
HOT WATER TANKS (oos)
l,a .9 St(JX VAe LLI(A„
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
i i /9 0,9
DUCTING
GAS PIPING
WOODSTOVES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE Ila Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing res to remain.
BATHTUBS (orTuh/shower comm)
LAVS (Hand sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
TOTAL BUILDING
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (stectric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Stories
Additional Information
NEW BUILDING
EXISTING/PREVIOUS USE
LOT SIZE Ila Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
ADDITION
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals —F E'°s' G PROPOSED TOTAL
**NEW HOMES ONLY"
ESTIMATED SELLING PRICE $ 1 # 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 in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 22, 2016 Page 2 of 2 k:\Handouts\Permit Application