15-105529'CITY OF 'A
Federal Way
COMMUNITY DEVEWFMENT SERVICES
253-835-2607• FAX 253-835-2609
www.ditjoffederalwau. om
PERMIT RQCLNEW MF �O ME PL DE E FP
APPLICATIOI�cr 2 9 2015
CITY OF FEDERAL WAY
SITE ADDRESS
S_2E5 Sw Zg
p
Y
sUITE/UNIT #
PROJECT VALUATION
$ 131 7q2.ao
ZONING
ASSESSOR'S TAX/PARC #
I L I v v
TYPE OF PERMIT
❑ BUILDING ❑ PLUBMING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION
NAME OF PROJECT
(Tenant Name/HomeoumerLast Name)
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
i
PRIMARY PHONE
MARMG ADDRESS
WMAD.
CITY
STATE
ZIP
NAME
1-4".f w
t3�77v Zeta
ADDRESS
�✓1 ifs-
/v
�l t+
CONTRACTOR
C
a!
STATE
641-
ZIP
V3"7',)--
FAX
rV_774)-66f6
WA STAW CONTRACTOR'S LICENSE #
/"24&±r 762r�
EBPDIATION DATE
FEDERAL WAY BUSINESS LICENSE 0
NAM
/laity,-tf Ai(Al /L 4
PHONE
Z5*3= 770 Z itv e)
MAILING ADDRESS
l�K 4cA,—
E-MAIL 1
Ntrtl
j;)C k, l ICD
APPLICANT
C114if11-�STA
23P
FAX F -77d-0636
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
S`Q
FROM
q ZS'3S�
MAUmG ADDRW
7.05- pi -k' ke—
WNWL
`� Di1ufLf/1 v [ot
CITY n lig
WA
!U3 T7)--
2
ALTERNATE CONTACT NAME:
Sf i�
PHONE
tC7-'7'7w 7100EM���ti
E-
PROJECT FINANCING
O OWNER-FEIZANCED
Required value of $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY. STATE. ZIP
PHONE
I cert{ fg 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 igformation 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 Inns 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 jUed against the city,
but only where such claim arises out of the reliance of the city, including its goUvrs and employees, upon the accuracy of the
irtformation supplied to ee
part of this application.
SIGNATURE:
DATE
�y/G✓/Ld/�
PRINT NAME' )Ile / h
Bulletin #100 -January 1, 2011 Page 1 of 3 k:\Handouts\Permit Application
A—
PLUMB� �LTLIR�S
Indicate how many of each type ofjixture to be installed or relocated as part of this project. Do not include extsting fixtures to remain.
BATHTUBS (or 1Ub/shower combo) LAVS (Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Httohen/uuuW WATER HEATERS (9ecuic9
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FISTURES
GENERAL INFORMATION
MECRAW
CAL TIRES
VALUE OF MECHANICAL WORN $
VALUE OF ZXMr NG BOROVEAGMTS
(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 (commerdA
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
PLUMB� �LTLIR�S
Indicate how many of each type ofjixture to be installed or relocated as part of this project. Do not include extsting fixtures to remain.
BATHTUBS (or 1Ub/shower combo) LAVS (Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Httohen/uuuW WATER HEATERS (9ecuic9
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FISTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PORVEYOR
SEWER PURVEYOR
VALUE OF ZXMr NG BOROVEAGMTS
EIIISTIIIG/PREVIOUS USE
LOT SIZB (In Square Feet)
zxurmG FIRE SPRunam SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
POMWTAREA arIT I I I I I
Bulletin #100 —January 1, 2011 Page 2 of 3 k:\Handouts\Pennit Application