11-103533F. 1A
Federal Way
COMMUNITY DEVELOPMENT SERVICES
253-835-2607• FAX 253-835-2609
www.cttuoffederaiLLau.com
PERMIT
APPLICATION
461 - - 10 --35i��3
SF MF (fff\fL t5 EN FP
RE
AUG 3 0 2011
SITE ADDRESS
28718 Military Rd. S., Federal Way, WA CITY OF FE DTRAEVVAY
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ 200,000
BN
5 5 2 9 0 0_ 0 2 3 0
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ENGINEERING CKFIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name)
Underground Fuel Tank Replacement
9 P
PROJECT DESCRIPTION
Detailed description of work to
Install replacement underground fuel tanks
be included on this permit only
PROPERTY OWNER
NAME
David Malik - Ambika Investment Co.
PRDdARYPHONE
(206) 841-3355
26220D116th Ave. SE #201
MAIL
dpmalik@hotmail.c
CITY
WA I
' 98030
NAME
TBD
PHONE
NLADdNG ADDRESS
E -MAD.
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NANZ SEE PROJECT OWNER
PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE I
ZIP
FAX
PROJECT CONTACT
Nrric Ramsin hiin
g (Bar gausen En gneerg�5)
656-7416
(The individual to receive and
1 RESS
821572nd Ave. S. era
i
sriQbarghausen . co
respond to all correspondence
concerning this application)
eKent
STWA ATEz>p 98032
Fi425)251-8782
ALTERNATECONT P1AME: PHONE
tan Goa Win (425)()'56-7441 dgo
E-MQII.
A n@barghausen.co
PROJECT FINANCING
NAME
El OWNER -FINANCED
Required value of $5,000 or more
MADdNGADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best
of my knowledge, the irtformation 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 offlcers and employees, upon the accuracy of the
Wormation supplied to the city as a of this a 1 ation.
Q
SIGNATURE: DATE
PRINTNAME• David Mali
Bulletin #100 - January 1, 2011 Page 1 of 3 k:\Handouts\Pennit Application
VALUE of MECHANICAL WORK sS
BATHTUBS (or 7Lb/Shower Combo)
(a copy of bid or estimate must be provided)
Indicate how many of each type of -lure 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 (Commercial)
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing furtures to remain.
BATHTUBS (or 7Lb/Shower Combo)
LAVS ([land Sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Frecmcl
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIKTIIRES
Bulletin #100 - January 1, 2011 Page 2 of 3 k:\Handouts\Permit Application