18-104528RECEIVED
CITY OF
,► SEP 24 2018 PERMIT APPLICATION
Federal Vt/a CITY of FEDERAL -WAY PERMIT CENTER +33325 8th Avenue South + Federal Way, WA 98003-6325
Y 0rmuNFvF DEVEI- wmA&T 253-835-2607 + FAX 253-835-2609 + permitcenter(dicityoffederalway.com
PERMIT NUMBER I V T _ I () q -5 Z S _ C—V N i h
— ✓✓✓ TARGET DATE
SITE ADDRESS
SUITE/UNIT M
3y503 (13rh F a1 W a %003
PROJECT VALUATION
ZONING
ASSESSO TAR/PARCEL k
$ CAroa
5-
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING X FIRE PREVENTION
NAME OF PROJECT
gk- vnbr%css M A cal Pay i lion Acs 1,6610 (t1 WI
PROJECT DESCRIPTION
Detailed description of work to
Come—VI-4,
'1- 1
be included on this permit only
NAME
C-libe
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS`
1Ave-l
E-MAIL
CITY1
STATE I
ZIP
NAME
per
PHONE
-4Zo
MAILING ADDRESS
1 3
E-MAIL
n
CONTRACTOR
CITY
kJATE
ZIP
q O
FAX
WA STATE CONTRACTOR'S LICENSE A EXPIRATION DATE
PERV
FEDERAL WAY BUSINESS LICENSE M
NAME
PRIMARY PHONE W
4 1,A
MAILING ADDRESS
1 c
E-MAIL
c
APPLICANT
CITY A
1
ZI^^P
('1 O
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
(�
ZS —
(The individual to receive and
MAILING ADDRESS
EMAIL
respond to all correspondence
CITY
ATE
ZIP
concerning this application)
FAX
PROJECT FINANCING
NAME
�I OWNER -FINANCED
When value is $5,000 or more
(RCW 79.27095)
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 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 a part of this application.
SIGNATURE: 31k�{ �I I 1 DATE Q I 1 l I ( _
PRINT NAME:
Bulletin#100 — January 29, 2016
A
e
f
Page 1 of 2
k:\Handouts\Permit Application
F -6-
U7
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 (In Square Feet(
$
Indicate how many of each type offixture
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)
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
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 (In Square Feet(
$
Indicate how many of each type o
re to be installed or relocated as
part of this project. Do not include existing fa -tures to remain.
BATHTUBS (orTub /shower Combo(
LAVS Hand Sink,
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
TOTAL BUILDING
DRINKING FOUNTAINS
SINKS (Kachcn/UU1ity)
WATER HEATERS (Electric(
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 (In 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 HXISTQIO PROPOSED TOTAL
"NEW HOMES ONLY"'
ESTIMATED SELLING PRICE $ I # 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
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
t OO
Bulletin 4 100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application