15-105694WCEIVED 0
CITY OF
NOV 09 2015 PERMIT APPLICATION
Federal Way
CITY OF FEDERAL WAY
CDS
-Z4
PERMIT NUMBER /
(yam/ _ ;� / ? - TARGET DATE
SITE ADDRESS
�q/8 sw 31 S YN STK£xT
SUITE/UNIT 8
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$ S00c)—
3 z! 0 Z o- c) o y o
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING 1kFIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
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Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
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MAILING ADDRESS
3 v.S i= .4 s cJ
E-MAIL
kU
CITY
STATE
ZIP
NAME
PHO Z /U90
MAILING ADDRESS 2-76-7--7
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E-MAIL
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CONTRACTOR
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FAX
F 1 73—yu—&/!;� O
WA STATE CONTRACTOR'S LICENSE M EXPIRATION DATE
RzFP 9 LF /a 05 /G,
FEDERAL WAY BUSINESS LICENSE M
9-1140/999 -00-AL
NAME
14 9
PRIMARY PHONE
7
MAILING ADDRESS
3 A yo s
E-MAIL
7-.
APPLICANT
CITY
P tr
STATE
1
ZIP
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FAX
NAMEQ J�
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PRIMARY PHONE G
PROJECT CONTACT
/
MAILING ADDRESS
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E-MAIL �
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(The individual to receive and
respond to all correspondence
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zIP ��,1Z y
7
FAx
253- ZZ-(visU
concerning this application)
PROJECT FINANCING
NAME
csogoaT4n OWNER -FINANCED
MAILING ADDRESS, CITY, STATE, ZIP Q taj
PHONE
Required value of $5,000 or more
(RCW 19.27.095)a
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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 cluing, 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.
DATE J/ 1-0/5�
SIGNATURE:Z�L�
4Aag2
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PRINT NAME: 7 '
Bulletin #100 - January 1, 2013 Page I of 3 k:\Handouts\Pernut Application
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•
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include existingfixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commerciaq
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
$
Indicate how many of each type of
flxture to be installed or relocated as
part of this project. Do not include existing tures to remain.
BATHTUBS (or Tub/Shower Combo(
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
Occupancy Group(s)
DRINKING FOUNTAINS
SINKS K,reben/utility
WATER HEATERS (Electric
TOTAL BUILDING
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 6 No
jKYes ❑ 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)
............................................................................ .................................. ............................
EXISTING PROPOSED TOTAL
Area Totals
"NEW HOMW ONLY"'
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Occupancy Groups)
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
Bulletin #100 —January 1, 2013 Page 2 of 3 kAHandouts\Permit Application