19-101786RECEIVED
CITY OF �"�� APS 16 2019
`► PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal ay cmU OF FEDE 253-835-2607 + FAX 253-835-2609 + permitcenter(p �cityoffederalway.com
COMMUNITY DEV MENT
PERMIT NUMBER 0 6�-p
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TARGET DATE
$ITE ADDRESS
7,&20 S0 3Zcst'`�
SUITE/UNIT #
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PROJECT VALUATION
$ c�
ZONING
ASSESSOR'S TAIL/PARCEL #
015c�-
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICALDEMOLITION F-1ENGINEERING FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME
CG �� L Z L�
PRIMARY PHONIC
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MAILING ADDRESS
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E-MAIL
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CITY�iJ¢
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$TATE
ZIP
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NAME - -5Z%t-v -r,
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CONTRACTORja
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$TA
ZIP
067,
FAX
WA STATE CONTRACTOR'S LICENSE #
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ERPIIiATION DATE
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FEDERAL WAY BUSINESS LICENSE #
NAME
PRIMARY PHONE
APPLICANT
MAILING ADDRESS I- -`/�
F,
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
PRIMARY PHONE
(The individual to receive and
respond to all correspondence
MAILING UM .S V) TGC
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CITY
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STATE
WAI
ZIP
C9 0 02
concerning this application)
FAX C 0"f
PROJECT FINANCING
NAME
❑' OWNER -FINANCED
When value is $5,000 or mare
(]?CW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
71
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the best
of my knowledge, the Wormation submitted in support of this permit application is true and correct. I cert(fy that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised 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), which may be made by any person, including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
irtformation supplied to the city asa pa of this application.
t
SIGNATURE: 4DATE / ✓
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PRINT NAME: L C K- �X- 44 o�-
Bulletin #100 - January29, 2016 Page 1 of 2 k:\landouts\Permit Application
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MECHANICAL PERMIT
Indicate how nuxny of each type offixture to be installed or relocated as part of this project. Do not include e)dsting fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (ca.)
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
Additional Information
sl
a
$
Indicate how many of each type offkture
to be installed or relocated as
part of this project Do not include exdstirkgfixtures to remain.
BATHTUBS (or7Vb/Shower Combo)
LAVS (Hand Sink.)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
AREA DESCRIPTION
DRINKING FOUNTAINS
SINKS (Kitchen/Utility)
WATER HEATERS (Electric)
# of
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
# of
Additional Information
sl
a
Stories
$ Q V
EXISTDIO/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
KYes ❑ No
❑ Yes ❑ No
COMMERCIAL — NEW/ADDITION
AREA DESCRIP'T'ION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Feet
a
Stories
�`IsiP
'Sqware
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
Type
Stories
TENANT AREA ONLY I Z 17- 4.9- I I I /
Bulletin #100 — January 29, 2016 Page 2 of 2 k:\Iandouts\Pelmit Application