18-105939 RECEIVED
CITY OF '�.i DEC 18 2018
PERMIT APPLICATION
V O PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
Federal Way CITY OF FERE 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER / 7 _ /0 5 9 `03 _ Fp TARGET DATE
SITE ADDRESS SUITE/UNIT If
Z-C) 0 SO Al" 3 fur sk. .4) )
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL II
$ 7000 0 9 Z l 0 ( ( - a Z g 74-
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING cgi FIRE PREVENTION
NAME OF PROJECT C0-)\---,it- 41 I NIA- V),,, .J,&J� f '
:
PROJECT DESCRIPTION `« .'4�" 5 y k..- - C,__Alt._ t'L'
J 1
Detailed description of work to
be included on this permit only
- _ - LL _
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS Y / -' E-MAIL
CITY STATE ZIP
NAME G )NSC. - -- 1 Ug —Dl�e S j�,,i PHONE 36L4 -L4
MAPOADDRESS 7 'SEE--MAIL L
CONTRACTOR ` O ciS 7 St-CA
(� ` 3W- SJ5L L 5 ` -
CITY
STATE ZIP
S(/AWA 4S`C FAX
r -
-- WA STATE CONTRACTOR'S LICENSE# 6 TION DATE� FEDERAL WAY BUSINESS LICENSE#
NAME ,N`S_ _..,(�.•i 5 Z t7,,. 11' PRIMARY PHONE
l,�c+� f� tel'- ;\k,e- S$\L., ZOe 3c, (ci-rj
MAILING ADDRESS E-MAIL
APPLICANT- Po
CITY STATE ZIP FAX
SQA 0\C- wA- c JtU C'
PRIMARY PHONE
PROJECT CONTACT AJ YPN(A../1 L- I-0 34 (°l-Q
(The individual to receive and MAIE-) aLING ADDRESS 3 E-MAIL ,
respond to all correspondence I S S�uG-,-- /v�
Co.
concerning this application) CIT pi (R — STATE ZIP f FAX .
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 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 WI as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim), which,ma a made by any person,including the undersigned,and filed against the city,
but only where such ci• •• arises out of the relian of the city, including its officers and employees, upon the accuracy of the
information suppl• • • t city asap•/•f t app tion.
, I&/ iSIGNATURE: i / DATE I it9 U
PRINT NAME:' 3(A.J YRw
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 Smks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Unhty) WATER HEATERS(Electric)
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)
S -91P-FWD?_ t ,• w M.y.,. Y .
COVERED ENTRY
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GARAGE 0 CARPORT ❑
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Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION S u Areare FeetpOccupancy Group(s) Stories in EOM' Additional Information
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AREA DESCRIPTION Area m Occupancy Group(s) Construction #of Additional Information
'uare Feet Stories
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application