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19-101639
CITY Federal Way RECEIVE[ A/a v APR a 5 2019 PERMIT APPLICATION CITY 0 PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325 EEE. AL WAY 253-835-2607 + FAX 253-835-2609 + permitcenter cot cityoffederalway.com COMMUNITY DEVELOPMENT PERMIT NUMBER /�- -0—L 4 -31- - F e— TARGET DATE l SITE ADDRESS < 7, _SUITE/ # PROJECT VALUATION $ 7�76_B� ZONING cc -r- ASSESSOR'S TAX/PARCEL # o g L © -�-�'' TYPE OF PERMIT El BUILDING El PLUMBING El MECHANICAL I] DEMOLITION ❑ ENGINEERING *FIRE PREVENTIODA/1. NAME OF PROJECT �2 �� 5���� ' co 7� 1171V /' xu I "9Z ° " PROJECT DESCRIPTION �w Detailed description of work to be included on this permit only NAME PRIMARY PHONE PROPERTY OWNER MAILING ADDRESS E-MAIL CITY _7STATE ZIP NAME �' n e PHON O G74 MAILING CONTRACTOR CIT � STA` ZIP �.` FAX (� �Olt TATE CO OR'S LICENSE f, EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # NAME PRIMARY PHONE APPLICANT- MAILING ADDRESS E-MAIL CITY STATE ZIP FAX NAME &V� eG �6 PRIMARY PHONE PROJECT CONTACT (The individual to receive and MAILI GAD RIFs .- /� ` SI �C�/ r (f respond to all correspondence concerning this application) �/' /1 i'�Gl l/ � I sTA z� D �7J FAx PROJECT FINANCING NAME OWNER -FINANCED When value is $5,000 or more (RCW 19.27.095) MAILING ADDRESS, CITY, STATE, ZIP PHONE 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 ), which may be m by any person, including the undersigned, and filed against the city, but only where such claim ses out,,df the reliance of city, including its officers and employees, upon the accuracy of the as information supplied to a city art of this apj / `- C_ DATE SIGNATURE: PRINT NAME: Bulletin #100 - January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application VALUE OF MECHANICAL WCW MECHANICAL PERMIT $ Indicate how many of each type offixture to be installed or relocated as part of 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 (cas) 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 NIS EVILDING EXISTING/PREVIOUS USE LOT SIZE )In Square Feet) � Indicate how many o each type ofjUture to be installed or relocated as part o 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 TOTAL. B01116M DRINKING FOUNTAINS SINKS (Kitchen/ Utility) WATER HEATERS (Electric) 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 NIS EVILDING EXISTING/PREVIOUS USE LOT SIZE )In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? ADDITION ❑ Yes ❑ No ❑ Yes ❑ 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) ................... _................................................. .- ............... ........... _.......................... _...................................... ............. ._._.. Area Totals EXISTING PROPOSED TOTAL ** wmomw 01YLY** ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS COMMERCIAL — NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information NIS EVILDING ADDITION COMMERCIAL — REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information TOTAL. B01116M TENANT AREA ONLY Ptt� Att>{ OI1LY -7,... , Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application