19-101794 A.._ _A, RECEIVED PERMIT APPLICATION
CITY OF
Federal Way APR 16 2019 PERMIT CENTER+ 33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@eityoffederalway.com
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CITYt�OF FEDERAL pWAAYY �/ Al/leg
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- I l _C +�M VJT'I�EY -T. NT / `� /
PERMIT NUMBER 1
_ TARGET DATE
SITE ADDRESS1 SUITE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 3� 00 (op7Ml'Q�•er4- I 3 - 7 go o - U O !• l
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING)(FIRE PREVENTION
NAME OF PROJECT �h/rd-PGZ e, /�le- 0Wil t lj ENGINEERING)(
PROJECT DESCRIPTION Ale oi" 'CC/P -77:.Z. 4(J/- �, 4cid<r4/0 2 Z--)Detailed description of work to P7a 5 7-� `7 Yl sc ' — /`/•Q s 0«�
be included on this permit only �/ ✓�T !A g4-1Z � ��
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7E PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME�Nf/,� / y / l�iD ��r- /. r/ �S X75^�/_7)4 /
MAIL/I//G ADDRESS :0 tie ✓ L Hl-sil` 4/2.'54t
CONTRACTOR Z 574:0";
-�GGG ��/ YBI� t
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CI S ZIP F C C) I
7'°?/ .
/�r[``E5CONTRA�'3LT " 1.✓ I L / / //f FEDERAL EXPIRA ION DATE IWAY BUSINESS LICEN/S/E.'#
NAME ea/ 579"4 ! 1 V C��/J O `" �'�I
MAILING/' SS �/ /�j
APPLICANT �/? 22 L'^7 4ag` CE-' ti tie)1� d#41,elf 2-!
- - - 1140'le,�/ n V� (/ P125-
RI} Y PHONFE //
PROJECT CONTACT N �et $� ,OU 12 5'^ 5 -33-'°7
(The individual to receive and MAILING ADDRESS7\ �j� r�3P� sry( 1f1��
respond to all correspondence jj Q �/ !q fiil��'
concerning this application) CITY 57 /'✓�TeTE- ZIP FAX C el.:e' . (C"
-- -- - NAME
PROJECT FINANCING A OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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 environm 1 tal laws.
I further agree to d • less the City of Federal Way as to any claim(including costs, expenses,and attorneys'fees incurred in
the investigation a•d defe se of such claim), which may be made by any person,including the undersigned, and filed against the city,
but only where ch cl• • es out of the/eliance of the city, including its officers and employees, upon the accuracy of the
information sup• led t•• he •• a part of is application.
011
,�� I / DATE 4l'-/ 'V 1
SIGNATURE:
PRINT NAME: /Q e/ `qr'(
-511-/2-/
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 fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commemul)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Krtehen/Utility) WATER HEATERS(Electno)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑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 0 CARPORT 0
OTHER(describe)
---- .--
EXISTING PROPOSED TOTAL
Area Totals
•*NEW HOMES ONLY*
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction # of Additional Information
Square FeetType Stories
NEW BUILDING f
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
TOTAL BUILDING
TENANT AREA ONLY / f'l•
PROJECT AREA ONLY �"T e
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application