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19-102379
` RECEIVED CITY OF 1.'.411111.10°F PERMIT APPLICATION Federal Way MAY 1 5 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607+FAX 253-835-2609+permitcentercityoffederalway.com CITY OF FEDERAL WAY C MU ITY DEV PMENT PERMIT NUMBER \ — 1 X1 - - TARGET DATE SITE ADDRESS SUITE/UNIT# ZozdS3Zo '`"/ 57 / o7 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ ?�s--v v © 9 Z ! o 44 - Z q7 TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING PCZIRE PREVENTION NAME OF PROJECT � O V A P CR cc ) 1 r- UM 1 °Kt 7; Z PROJECT DESCRIPTION rAI g r,.- L Al Cc V..., S p K Il M I+C C..a-ies Detailed description of work to 1#4 14 Lc W T 1 r be included on this permit only NAME W / e`G /�C PRIMARY PHONE PROPERTY OWNER K .J CADDRESS` AiTLcit ' Zoo L c- C E-MAIL/ q02, r . (�„K.ts S 7 CITY , FIPIl C e STATE Z?9 / 22 / NAME "/ /I { SP04*VVCM LL c PHONE S 3 -277-3Z L 8 MAILING ADDRESS/ . / (V r. E-MAIL / CONTRACTOR 4'Z 0 g V S V KIV td IJ4y /V` 7 CITY STATE ZIP FAX 19.07vgoa Wft faoO' . WA STATE CONTRACTOR'S LICENSE♦ EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE i SsrfIFS84 $.121: lZ i Si//? NAME PRIMARY PHONE 5*Al c.t APPLICANT MAILING ADDRESS E-MAIL CITY STATE ZIP FAX PRIMARY PHONE AME PROJECT CONTACT N1:?l .s. 13 tz Cu Cr-rt gZSr= e Q/ y 9 O p (The individual to receive and MAILING ADDRESS 10-MAIL respond to all correspondence 5-AMC% sICK4 $ea t c e 10 concerning this application) CITY STATE ZIP FAX'jl/Ee',OL U TI(1 Ali c CI Hot NAME PROJECT FINANCING 0 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 authorised 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 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 information supplied to the city as • •• of application. SIGNATURE: r/ DATE F7 /4)----17 PRINT NAME: • 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 of fixture 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(Commercial) 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(Kitchen/Utdny) WATER HEATERS(Electric) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS $___7 o EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? Wes ❑ No ❑Yes ❑ No RESIDENTIAL - NEW OR ADDITION AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE FIRST FLOOR(or Mobile Home) -' `4 - . COVERED ENTRY GARAGE 0 CARPORT 0 • Area Totals =STENO PROPOSED TOTAL ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL—NEW/ADDITION AREA DESCRIPTION Area is Occupancy Group(s) Construction W of Additional Information Square Feet a Stories ADDITION COMMERCIAL—REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area Occupancy Group(s) Construction Y of Additional Information Square Feet Type Stories TC1�Af.: TENANT AREA ONLY Bulletin#100—January 29,2016 Page 2 of 2 k:\landouts\Permit Application