19-101733RECEIVED PERMIT APPLICATION
CITY OF 4::k�
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
Federal Way APR 11 2019 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
MMUN D L M
PERMIT NUMBER _ _7 3 _ TARGET DATE
SITE ADDRESS p K 110
,� Z off= er C e- ,I r- 6 --
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$bsiyoo
7
3>�7— 0-o- C�vaa
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
C L 2 G (/ `��I I e S
PROJECT DESCRIPTION
Detailed description of work to
r
be included on this permit only
NAMEPRIMARY
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PHONE
PROPERTY OWNER
MAILING ADDRESS /
E-MAIL
CITY � O /�
STAT
NAME
PHONE
CONTRACTOR
MAIL ADDRE S �('
E-MAIL
CITY
/�� �" /
STWT,
Gf/
ZIP
o I
FAX
I F CONTRAKO ' LICE SE 0
-
EXPIRATION AT
/
FEDERAL WAY BUSINESS LICENSE #
NAME / / ��(� /� ((D _
C_L/ !�
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
L ,Q J,f'�i^ ,
CITY
STATE
ZIP
FARC/
PROJECT CONTACT
NAME (
f 7 ✓� /D
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
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. 1 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 hgvm1vjs the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in
the investigation and de se of ch claim), which m be made by any person, including the undersigned, and filed against the city,
but only where such aim es out of the relt a of the city, including its officers and employees, upon the accuracy of the
information supplie to the as of this lication.
1J /fes
SIGNATURE: DATE L
(
PRINT NAME: e G C
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
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 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
# of
Stories
Additional Information
NZ'BU=IHG
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
$
Indicate how many o each type offixture
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 Silii t! IQ
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
NZ'BU=IHG
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
**lYW HOSM 01czn•
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NZ'BU=IHG
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL Silii t! IQ
TENANT AREA ONLY
#1WJEGT AREA ONLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application