17-100774KtULIVED
FEB 16 2017 PERMIT APPLICATION
CITY OF CITY OF FEDERAL. WAS
Federy� ��%RMIT CENTER + 33325 81h Avenue South +Federal Way, WA 98003-6325
al ■ a CDS 253-835-2607 + FAX 253-835-2609 + permitcenter(a,cityoffederalway.com
PERMIT NUMBER _ 1 0 o -7 -7 y_ C o TARGET DATE 3L3 I
SITE ADDRESS ' Z (o . , 3;2 4 tir C SUITE/UNIT#}i
/ CeOMeA
(✓ V
PROJECT VALUATI— ZOh._ _ ASSESSOR'S TAX/PARCEL N
�M'sw C)d -L 5— 0 5—
TYPE OF PERMIT
BUILDING Lp PLUMBING X MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
-
l
dd c—.o /
PROJECT DESCRIPTION
Detailed description of work to
i c�✓�/1C /YLJ
v tz-- ., U/ ml
be included on this permit only
PRIMARY PRONE
�T�
,,,,
OZ* iJ
PROPERTY OWNER
MAILING ADDRESS
/ I W '5M lm
E-MAIL
' ca TI
d) 1
z7) Z0
-!ill- 63�
NAME
Lery L C-
PRONE
- c. 6S
MXILING 'ADDRESSE
uA)E
L �7�1I%+ir C
CONTRACTOR
CITY
V, r
STATE
ZIP,
y& TL -
FAX
WA TE CONTRACTOR'S LICENSE ERPIRATION � TE
FEDERAL WAY BUSINESS LICENSE B
NAME
PRIMARY PFInUP
APPLICANT
NO ADDRESS
%) �/�
E-MAIL .
0-O Y
CI STATE ZII'
..
FAX
PROJECT CONTACT
NAM
PRIMARY PHO �/
—,3
MAILING ADDRESSii
2—o `nE 1 r
E-MAIL
(The individual to receive and
respond to all correspondence
CITY '
STATE
CA---
Z�
FAX
concerning this application)
PROJECT FINANCING
N Mea 1 eft,
0 OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING AbDRX CITY, STATE, ZIP
PHONE _
AD 93Q
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 thts ap n.
SIGNATURE: DATE
PRINT NAME: /.) J
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\iandouts\Permit Application
'/Yk4�
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Occupancy Group(s)
Construction
$ C.1®
Indicate how mang of each type offiLyAtre
to be installed or relocated as
part of this project. Do not include existing fixtures to remain.
SQQ. 0O
Indicate how many of each hipe 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 )Camme -a)
BOILERS
FURNACES
HOT WATER TANKS (Gas)
C
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
.i TOTAL FIXTURES
DUCTING
GAS PIPING
WOODSTOVES
# of
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Occupancy Group(s)
Construction
$ C.1®
Indicate how mang of each type offiLyAtre
to be installed or relocated as
part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/shower combo)
LAVS (Hand Sinks)
CX TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS )Kitchen/Utility)
WATER HEATERS (electric)
C
HOSE BIBBS
SUMPS
WASHING MACHINES
.i TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
Occupancy Group(s)
Construction
# of
Additional Information
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Stories
[Yes ❑ No
❑ Yes ❑ No
iYlAi'Ti K(,_ 75
77777
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Ar68 in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
a
Stories
�E9[ �UiiIliHt#
77777
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area is
IOccupancy Groupls)
Construction
I
# of
Additional Information
Square Feet
I
Type
Stories
TENANT AREA ONLY 3'
Bulletin #100 - January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application