18-1034974ik
CITY OF
Federal Way
PERMIT NUMBER
C
PERMIT APPLICATION
PERMIT CENTER + 33325 8f Avenue South IVED8003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
AUG 0 7 2018
I
CITY OF FEDERAL WAY
— TARGET DATE ;OMMIJN13:�t DEV€6.9PM€!VT
SITE ADDRESS
32- (,--!)O k 'Sz,,)�
SUITE/UNIT #
too
PROJECT VALUATION
$ao0
ZONING
ASSESSOR'S TAR/PARCEL # O O
2 1 54 5-----
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING XFIRE PREVENTION
NAME OF PROJECT
1,
o%)�jn t r) oL
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME Apr Z
PRIMARY PHONE
PROPERTY OWNER
' 1 aj,?d
MAMING ADDRESS
E-MAIL
CITY
STATE I
ZIP
e- eC,na fo LL
PHONE
jl 5 -qo'S- C 5$3
MMAILING ADDRESS
` ( 1
E-MAIL _
e 6-5 cam- eco,
CONTRACTOR
ITYSTATE
J.Ae
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
/in
FEDERAL WAY BUSINESS LICENSE #
"5- 10 660')
NAME
Ctic ow 15
PRIMARY PHONE
20c� -)3/- 3f L
MAILDRE3j� 1
EMAIL �" eC�
APPLICANT
ITY
r W("-,�
STATE
W A
ZIP
C) 1
FAX
'
PROJECT CONTACT
NAME ]
C) ate- ca y o w -
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 of such claim) 7hich maybe made by any person, including the undersigned, and filed against the city,
but only where such claim ari ut o relianc of the city, including its officers and employees, upon the accuracy of the
information supplied to the c' a p this appli ation.
% �n
SIGNATURE: DATE / C>✓
PRINT NAME:
Bulletin #100 – January 29, 2016 Page 1 of 2 kAl-landoutsTermit Application
51Z
MECHANICAL PERMIT
Indicate how many of each typ
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
PLUMBING PERMIT
Indicate how many of each ttyp
BATHTUBS (or Tub/Shower combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
HOSE BIBBS
Ffucture to be installed or relocated as
FANS _
FIREPLACE INSERTS _
FURNACES _
GAS LOG SETS _
GAS PIPING
Ffixture to be installed or relocated as
LAVS (Hand Sinks) —
RAINWATER SYSTEMS —
SHOWERS —
SINKS (Kitchen/utdity) —
SUMPS
VALUE OF MECHANICAL WORK
f this project. Do not include existing fixtures to rem
GAS PIPE OUTLETS OTHER (Describe)
HOODS (commercial(
HOT WATER TANKS (Gan)
REFRIGERATION SYST
WOODSTOVES
VALUE OF PLUMBING WORK
A.
)f this project. Do not include existing fixtures to ren
TOILETS WATER PIPING
URINALS OTHER (Describe)
VACUUM BREAKERS
WATER HEATERS (Electric)
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR -
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
Area in
.. ..... _......... ............................. .......----._... --' -- --
FIRST FLOOR (or Mobile Home)
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Additional Information
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED TOTAL
FOR OFFICE USE
Area in
.. ..... _......... ............................. .......----._... --' -- --
FIRST FLOOR (or Mobile Home)
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
_._.._.._............................................................._........ ......... _... _........ --- ...... _....- -._._... _....... .... _
COVERED ENTRY
a
Stories
MR
12
GARAGE ❑ CARPORT ❑
•`+ .•£ §� 7wx.' p %x8io-" 'S;
,�
Jf, r``
t i i+ r x�$,k�- ;�grr ,X x ". ':
_.....—___—.__—_._—_—._...._....__._—..._.---......__...—__.....--.-' -
Area Totals
EMSTING PROPOSED TOTAL
xtfr' 1^ `w
.9%fiXo '; • .Y.,
'3'�y# %'Jtx fay �;
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
Area in
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
Square Feet
a
Stories
4h
rs »;Q. si L» mF,..id
xtfr' 1^ `w
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
Area in
Construction
# of
AREA DESCRIPTION
Occupancy Group(s)
Additional Information
Square Feet
Stories
.,,;�r/`.ezy
5
TENANT AREA ONLYJo
.kms '
•r -may .r5 y r ,. 0 j. .
o
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application