19-101083i
CITY OF
Federal Way
PERMIT NUMBER / 4 _
RECEIVED PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
MAR o 8 2019 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
C;'Fy OF: FE('cRA. WAY
CA�NMUhii7Y�}E'y����' J-
- -Elp TARGET DATE
SITE ADDRESS
SUITE/UNIT #
32-2 90
/ s r- AVe S
PROJECT VALUATION
ZONING
ASSESSOR'S TAR/PARCEL #
$ oav
> 7 Z I-
9 0 ,7 9
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING WIRE PREVENTION
NAME OF PROJECT
QY�vk1iT►!i5''V S
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
.BXoc'K-ag4C- SEN/alt LIvi^4-
S3- b:3t'-a'So?3
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
6737 w r -As IA)&Tory S7- -V-rte 30L
CITY
M14;VAVKEe
STATEZIP
w
s3a
NAME
Q TV CC-TfZ)
PHONE
0206- 5 75 -O$37
MAILING ADDRESS
o 3 6 5+11 V E N E 5 tl �
E-MAIL
U N, �cf�c pC . CQ
CONTRACTOR
CITY
2ELiNE
STATE
w Pt
ZIP
9W1 SS
FAX
Z06 -ff7S -777v
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
V/UlrYCL L
NAME
PRIMARY PHONE
UNI? EI.EC-T/ZIC
O{�-S`75--OiS3-7
MAILING ADDRESS
0306 1SO i� NE
E-MAIL
gmD Ivt k1-�'qic.coM
APPLICANT,
CITY
s ozc E
STATE
v,R
ZIP
V
FAX
,�06- s 7 s ---77v
NAME
PRIMARY PHONE
PROJECT CONTACT
uruI
;2DQ - S7 S - or 3 �
MAILING ADDRESS
.2o -3o6 I s'4 LjE 1v S u, rc"
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
EUS
STATE
wP
ZIP
48 SS
FAX
0 's75"'v�S37
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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
ail 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 reUanc the city, including its officers and employees, upon the accuracy of the
of this a
information supplied to the ci7;�—
l /
SIGNATURE: !i%
DATE
PRINT NAME:C-
Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many o each type offixture to be installed or relocated as part o this project. Do not include existing res 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
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
VALUE OF PLUMBING WORK
PLUMBING PERMIT
FOR OFFICE USE
fkh.,'�d
A-
Additional Information
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
$
Indicate how many of each type offixture
to be installed or relocated as
part of this project. Do not include existing res to remain.
BATHTUBS (or Tub/Shower combo)
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
G �. ASPS i✓`
DRINKING FOUNTAINS
SINKS (Kitchen/utility)
WATER HEATERS (Electric]
AREA DESCRIPTION
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
FOR OFFICE USE
fkh.,'�d
A-
Additional Information
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
"PROPOSED
TOTAL
FOR OFFICE USE
fkh.,'�d
A-
Additional Information
Square Feet
............................__....
•fi
Stories
'.f % ,
FIRST FLOOR (or Mobile Home)
,''
R%�U
__. _........_............... ......................... _................... _.............. _ _...........__.__........ -........... -
G �. ASPS i✓`
4 k �.«
+U . ,-}
61M"i " tX?'✓
AREA DESCRIPTION
COVERED ENTRY
Additional Information
Square Feet
Stories
p-'--.....
f
___-.......... _.... _._................ ...................................................................
x`
4
e£3r
GARAGE ❑ CARPORT ❑
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Area Totals
EXISTDIG
PROPOSED
TOTAL
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
Area in
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
Square Feet
a
Stories
'.f % ,
a,� o-}.. r .s `4 's,,{✓ f
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
Area in
Construction
# of
AREA DESCRIPTION
Occupancy Groups)
Additional Information
Square Feet
Stories
,•
f
r �.
4
AN
TENANT AREA ONLY
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Bulletin #100 —January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application