12-102610` My or
Federal Way
COMMUNnY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
www.cituoffederalwati.com
PERMIT
APPLffi§kftbN
JUN 08 2012
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SF MF CO E PL DE EN FP
SITE ADDRESS CITY ° F FEDERAL wS\A
SUITE/UNIT #
35 ti o S �1�►G � W-,( 50 ,
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ SAP d opo ,
GE
°� 2 1 O - 0 R <o
TYPE OF PERMIT
)(BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION 'ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
rrenant Name/Homeowner Last Name)
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E*arlm\ 6 9
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
M'q r c O
PRIMARY PHONE
U01. Z.b3 (OSOOL
MADJNG ADDRESS 1 N
2 er
E-MAIL
C
TATE ZIP
Ulsto
NAI,E ` � tq...
Dlo•loist—S�10
`DRF`SS�� s. . a _Lau
CONTRACTOR
C `
wST�TE
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FAX
tri
WA STATE CONTRACTOR'S LICENSE ##\ EBPIItA ON DATE
ERAL WAY BUSINESS LICENSE #
tob�
PHONE
(OWL qbw(DT
APPLICANT
11AII7ING ADDRESS ( �.,%E
1`�\`FAX
CITY �
PROJECT CONTACT
PROJECT
th �` `
`
PHONE 300
(lice individual to receive and
VINO ADDRESS
U�P'iI 16k�
respond to all correspondence
concerning this application)
,
CITY
S'I�TE
W�
ALT ; TACT NAME LAThy"
PHONE % 1a0� i��
E-MAIL
PROJECT FINANCING
NAM
,
OWNER -FINANCED
Required value of $5,000 or more
(RCW 19.27.095)
M�-G�DRESS� a1 � � n W! -
/► M
�2 PHONE
I certify under penalty of perjury that I am the property owner or authorized agent of the property oowner.II 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 oris outreliance of the city, including its officers and employees, upon the accuracy of the
information su lied to the city p f t is ap li tion.
SIGNATURE: DATE
PRINT NAME: LQ
Bulletin #100 -January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
CA"
VA,
010-
Bulletin
10-
I T/ Ir' VALUE OF MECRAWCAL WORK $ (a copy of bid or estimate must be provided)
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commercisi)
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
Ir(dicate how many of each type of fudure to be installed or relocated as part of this project Do not include existing fixtures to remain.
BATHTUBS (or nub/Shower combo)
LAVS (Hand Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (wtchenNuhry)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FI KTURES
4 Nip .04 rnLg or
_..__.F r�.:_...:a�.�......_ v %€ ;�.-.:p��'!s-'-�: ...�..'51+�x?,..i,
CRITICAL AREAS.` ON PROPERTY?
WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
\.
IN�,E_o
`.P4\0E ht �tr..R
Stories
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet) EBLSTING FIRE S R SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
w A �-
❑Yes ❑ o ❑Yes No
--------------------
AREA DESCRE-PTION (in square -feet)
FIRST FLOOR (or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
Area Totals
ESTIMATED SELLING PRICE
EffiSTQira ) PROPOSED 1 TMAL
# OF BEDROOMS
FOR OFFICE USE
AREA DESCRIPTION
Area Occupancy Group(s) Construction # of Additional Information
in
ware Feet
Stories
11 1.0 i', @r ,"
ADDITION
AREA DESCRIPTION
Area Occupancy Group(s) Construction # of Additional Information
Feet
Type Stories
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$ t� ;: ss.� l�( i;f7 �3A� �.E!§.,
TENANT AREA ONLY
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Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Perniit Application
41k
• CITY OF�wr�'�
Federal Way
•
RESU BMITTE11EPARTMENT OF COMMUNITY DEVELOPMENT SERVICES
33325 8`h Avenue South
25
JUN 1 S 2012 Federal Way, WA 98003-6325
3-835-2607; Fax 253-835-2609
CITY OF FEDERAL WAY www.citvoffederalway.com
CDS
RESUBMITTAL INFORMATION
This completed form MUST accompany a// resubmitta/s
"Pleasenote Additional or rewsedplans or documents foran active project w// not be accepted
unless accompanied by this completed form. Mai/ed resubmitta/s that do not Include this form or that
do not contain the correct number of copies wi//be retumed or discarded. You are encouraged to
submit all Items in person and to contact the Permit Counterpr/or to submitting ifyou are not sure
about the number of copies requires! **
ANYCHANGES TO DRAW/NGSMUSTBECLOUDED.
Project Number:
Project Name:
Project Address:
Project Contact:
\ IL - k 0 02% 14 \ 16. -
o 0 - C,,O
Phone: -Z6
RESUBMITTED ITEMS:
"Always submit the same num of copies as required foryour/n/dal application.'"
V6-.-�
Resubmittal Requested by: Letter Dated: el Aa
Bulletin # 129 — January 1, 2011 Page 1 of 1 k:\Handouts\Resubmittal Information
Deftiled DescrIption of Item
■
"Always submit the same num of copies as required foryour/n/dal application.'"
V6-.-�
Resubmittal Requested by: Letter Dated: el Aa
Bulletin # 129 — January 1, 2011 Page 1 of 1 k:\Handouts\Resubmittal Information