19-102650 RECEIVED
_ _A. PERMIT APPLICATION
FCITY OF JUN 0 3 2019 PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
ederal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY 07 FECFFALWAY
�j ,^,Ohjl�Ut' Y DEVELOPMENT
..............................)
PERMIT NUMBER / 7 _ / // 2 /if 5-0 _ floTARGET DATESITE ADDRESS t3�/ �(CSUITE/UNIT#
-
C(IC) S 333' STI
PM {rc . t l�c-.- , i W A- (1s-1,0.3
.
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ �0Q°er* - - - - -
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING A FIRE PREVENTION
NAME OF PROJECT !c),.Ot t vto5 T e-11$
PROJECT DESCRIPTION -tv,5.-(A l( C rC o Ar tC.^^ 5 y54-c I'--,. -1;1N Y'a 0 6 4 ou 4- C3(dee,
Detailed description of work to P k 0,-5 t-- I- l J ;c - d Q.,(4-We ri-L►cvS,c.-) (/.9 f It. Ib-.e_ Ca,Mn/e k-e S-
be included on this permit only •1 : l r
kt-* Ct;n CIGCd.JPh"ICY (�1^�tCC Z �,.9: tt toA - 4uL At Te
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NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
`
CITY . PAC- L.-,i-STATE ZIP PHONE
NAME \91‘01- l LL Ck R ,i- 3._ 7-31— 1_5-
MAILING
MAILING ADDRESS .----
E-MAIL
CONTRACTOR 1S 1'2j lJ 5r' et-ut CT
CITYSTATE ZIP FAX
ECe �{
(pJ
WATATE CONTRACTOR'S LICENSE# W EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Nk391-- 6-ZCLS2=f-tZc. \Z- A23 /2azD
NAME PRIMARY PHONE
LCO 171"5--"C- zS3431--'7-01---5.
APPLICANT- MAILING ADDRESS E-MAIL
NS k. \ \ A-u- CT C 10 ek K ..VI ct 2 avva l't d 4A1640c..J 0Ot/� �J CITY STATA ZI613 P - -3 Z FAX
NAME PRIMARY PHONE
,L
PROJECT CONTACT Leo 1,1-.9'7— . 2-S —..1-3 7- - is
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 1t 3 10 S"h Ave__ C T- 10rt I.Ct IGI.9l Z9"-141). (` .4,
concerning this application) CITY STATE ZIP FAX
C
NAME .....
PROJECT FINANCING Igi 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 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 supplie• to the ci - • a •art of this application.
0
SIGNATURE: �. DATE qv!)I
PRINT NAME: Le 0 11----0 1---
Bulletin
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(Commermal)
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/Ugly) WATER HEATERS(Electnc)
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
'biOg
..4_,.„..-:.,,„ „. .., .-_-- ?u ,'t:, ,,." „*.:,"„1,..,',.;.:._,_.',;„4,4',. ..�_.:,.w„Y:..w,r. .._::i4..+,:2;.:;--„,4 .a:is. -- — — — — --
GARAGE 0 CARPORT 0
Ot iOR(describe} ', a '
EXISTING PROPOSED TOTAL
Area Totals
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
.. ...:”: ".NEW BUILDING"M" ',:::}"=i'r' :s.4.;:i7.; 4 ti= ,...4..,,''..--.---4-.„-;;-`:z. ,'„:,. —,, . ,. .y _ _ M,,- h. #
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area rea in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
+:!k '2i,+s " 1.4.,', ,',014,<-44:1A,4-"-444'* SYti r." ;c r '' :' 'sY''''' 'e': :'''%
TOTAL 711UII.DINO
x.;,.
TENANT AREA ONLY
PROSEeT AREA ONLY t 4 •
y,.
' c. - ,4,1'..1,-.• '., p
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application