19-1016364ik
CITY OF
Federal Way
RECEIVED
APR 0 5 2019
S (-10 Oe
PERMIT AP LICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Cl ry QF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 + permitcenterc�cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER _ / � _
TARGET DATE
SITE ADDRESS.-SUITE/UNIT
?4d
#
PROJECT VALUATION
$ 0 S"�
ZONING
c C-
ASSESSOR'S TAR/PARCEL #
f2 � C2
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING FIRE PREVENTION F
NAME OF PROJECT
�AX 1,5 41 rig
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
ps 'lei �N —' Z xi�d
O 5�
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
NAME P -J n Q
`,
PHONE
�7
CONTRACTOR
Qom)
MAILING ADD����� � /"'C- C • � F,E-MAIL
C r
S,TAJj�
ZIP
FAX
ST/ATE CONT OR'S LICENSE #
1
EXPIRATION DATE
2 l/ l /
FEDERAL WAY BUSINESS LICENSE #
-
NAME 2"r
PRIMAJRY PHONJ/
MAILING � � �R,As a
I ✓v
E-MAIL//
APPLICANT
CITY �'��r
V
STATE,
FAX
PROJECT CONTACT
NAME -
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. 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 ch claim), which may a made by any person, including the undersigned, and filed against the city,
but only where such clai arises out of the reiianc of the city, including its officers and employees, upon the accuracy of the
information supplied to city a p of this app cation.
/
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Pennit Application
MECHANICAL PERMIT Is
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
PLUMBING PERMIT
Indicate how many of each type offmWre
to be installed or relocated as
part of this project. Do not include existing res to remain.
BATHTUBS (or Tub/shower Combo)
LAVS (Band sinks)
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
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
NEW BUMDINCC -
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 EffiSTING PROPOSED TOTAL
**N waonzs oMr►=
ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area In
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUMDINCC -
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BtMMO
TENANT AREA ONLY
PROJECT Afi A OOLY
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application