19-101875 t
A ;. E E11�ED PERMIT APPLICATION
CITY OF
Federal Way�//�(Jay j 7Q19 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(lcitvoffederalway.com
WAY
•
PERMIT NUMBER 1 O �MMUC I Y DE ELOpM�'� - Ff N'
TARGET DATE
SITE ADDRESS� �O �� `C�� 4( 4� a 5 �� r I 124 (,iC-
BUTTE/UNIT M
PROJECT VALUATION ZONING ASSESSOR'S TAX/P CEL#
$ -z S l a av D N 2 1 U (I - 61 O 3 .-5
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 0 ENGINEERINGA FIRE PREVENTION
NAME OF PROJECT 5 4°1`C e it 4 I 9- g fov.4 .2
11 x S
PROJECT DESCRIPTION .x4` I( N e,) F1 'a!M c` k*i !
,.� ) � S�/4�
Detailed description of work to /Vet-)eCa c-tif it
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP /� / t.
NAME 5 ,.AI ,(veceI P 6 3D 1 -199k
MAILING ADDRESS E-MAIL
CONTRACTOR 1)0 �0 - 9 S3 1 1vCw449$...d i ejika;/,a'..,
CITY C4 44 I(
STATE ZI (O 1
V/,I FAX
(2D,(,-1D-) Wt STATE LICENSEk EXPIRATION
FEDERAL WAY NSCa6 / Z�/ 1' �o4, /eOO !(,—(7W`�L
NAME PRIMARY PHONE
Saw`e
APPLICANT MAILING ADDRESS E-MAIL
o2 �s 1 /,/g CITY STATE ZIP FAX
,( Vr N PRIMARY PHONIC
PROJECT CONTACT Y B) 5,24,..,5 ZD 6 1'4 6 33 3
(The individual to receive and MA G AIj�RE. Q c ',grate(
j yt q' near( I;e t
respond to all correspondence ;i1'`"n'J7T wi fi C
concerning this application) CITY-a f 1,(DYl'STATE ZIP^ (O 7 FAX
NAME
PROJECT FINANCING 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW]9 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 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
information supplied to the ty as a part of this application.
SIGNATURE: r IDATE tjji > il?
APRINT NAME: e r a 1 d 6,p... ,
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application •
i •
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(comm,c,aq
BOILERS FURNACES HOT WATER TANKS pa*)
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) LAYS HoodSIoke TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS Kdrhen/Utahry) WATER HEATERS(Eieoinr
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
FIRST FLOOR(or Mobile Home) --
COVERED ENTRY
GARAGE 0 CARPORT 0immi
Area Totals siaaTiNc PROPOSED TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in EMI #of
AREA DESCRIPTION S urea Feet Occupancy Group(s) Stories Additional Information
,.t.i,#+t•,y-.- �a,........0,1- it
r ..y i t .^91'Le -
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION MEM Occupancy Group(s) Stories Additional Information
TENANT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\I-Iandouts\Permit Application