The URL can be used to link to this page

19-101839` RECEIVEDCITY OF �S/ •� � Q 2019PERMITAPPLICATION AP © MIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325 Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter ccityoffederalway.com CITY OF FED - F: iA1 WAY COMMUNITY DEVEI..OPMEN PERMIT NUMBER _ Z La, L t1� _ � TARGET DATE SITE ADDRESS^ y C `%J / / �' '3�i/ � ! CES SUITE/UNIT # PROJECT VALUATION $ 7 ZONING ASSS S TAX/PARCEL # CJS /-3 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING AIRE PREVENTION NAME OF PROJECT 41 kVI4 PROJECT DESCRIPTION Detailed description of work to be included on this permit only NAME -' ! PRIMARY PHONE �"z n � 'S 2s `334;� - 0-?; PROPERTY OWNER MAILING/ E-MAIL AD J G ��'�r% �%es U%, fJ " t/oy.f CITY/ STA E ZIP C (/ n NAME1�Q 4 4 ' /�� PHONE / LJ (!�`� MAILI G ADDRESS G E-MAIL#A Z� ? v� 5 v eJ V— C (7 CONTRACTOR CITY STATE ZIP FAX 20(�- 2 2 10 WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # NAME PRIMARY PHONE MAILING ADDRESS E- L 1� &:, jC APPLICANT CITYSTATE ZIP FAX 7 6 % ' p'L9p NAME PRIMARY PHONE �G �� Q S PROJECT CONTACT 0 MAILING ADDRESS E-MAIL (The individual to receive and respond to all correspondence CITY STATE ZIP FAX concerning this application) PROJECT FINANCING NAME �S rrOWNER-FINANCED When value is $5,000 or more (RCW 19.27.095) MAILING DRESS, CITYy�TATE IP , 1 PHONE -, C v -) ��' �, � �j- `7 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 o ch claim), which may be made by any person, including the undersigned, and filed against the city, but only where such claim se out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to t city as a part of this application. DATE SIGNATURE: PRINT NAME: Bulletin #100 — January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application fa VALUE OF MECHANICAL WORK MECHANICAL PERMIT Indicate how marty 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 EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) $ Indicate how many o each type offLxture 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#, 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 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 ❑ ...................................... ....._. ... ..... .... ----- OTHEI�i describe) - ---....._._.......... ............. ._......_.. __._ .._:... ._..................................... Area Totals EXISTING PROPOSED TOTAL **IWWEOJM ONLY%* ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction Type # of Stories Additional Information ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(m) Construction a # of Stories Additional Information TOTAL#, TENANT AREA ONLY PR64710i AREA ONLY Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application