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CITY SF IIPIBlliknorr, • RECEIVED. PERMIT APPLICATION
Federal Way 1 PERMIT CENTER+33325 86"Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenteriicityoffederalwav.com
APR 2 4 2019
n CITY OF FEDERAL WAY A
PERMIT NUMBER `i _ lomtiNITIDedrapir _ r
DATE mitt-
TARGET
SITA ADDRESS Q 1
2462.0 S O 3 Z C3+.1q _ V ( r' 1 , a \ \'ZMUTE/UNIT#
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
TYPE OF PERMIT Cl BUILDING ❑PLUMB]NG 0 MECHANICAL 0 DEMOLITION ❑ENGINEERING KEIRE PREVENTION
NAME OF PROJECT V\. i.A' C r
Ale ' rt a :r i
PROJECT DESCRIPTION
,, IP' r Pa i•Lt !C L CV-it.
Detailed description of work to
be included on this permit only
I
NAME'',,`/ -— - - - - PRIMARY PHONE
PROPERTY OWNER141 � C "� 'j�/ PL•r7- L 204-€a3 '3 Or
r'i o2 E. ?I E-MAIL
S,v ;��6 Nivicc,
ZIPCITY STATE Z
.1---
NAMEin
PHONE
�
/ t T f, rt f,,, :• �vr—ioai.r L i–C- ZS" —7 77 3LQ:
CONTRACTORMA/LING ADDRESS.-7 Z/v 13,13 W Al /SC// s-1 PI G/C I t. E R4‘911
Ids/J, Q /S`TF/�tctJ'oiten o.t/.Pr tY
CITY,/� STATE ZIP FAX
/5F V Sc.,4.4 twit 98 O a 2
WA STATE CONTRACTOR'S LIMN,i. EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE S
ilrfrfs 8C F f 3/ //,
NAME PRIMARY PHONE
APPLICANT MAILING ADDRESS f/414(, . E-MAIL
CITY STATE ZIP FAX
NAME---- PRIMARY PHONE
PROJECT CONTACT 1R1,G I L 13 6--g. 6/ 42 j-:84 7_4 f 07
(The individual to receive and MAILING ADDRESS :MAIL [k t CK �R.4 n
respond to all correspondence Af l tics U&LIRA( , .v AL •S V 1 TC.'G 7 . ly�'/G/Rg Sot CI Tf ilii
concerning this application) CITY STATE ZIP FAX s C 0 4'f
BU6� wa P� o 4..t.
NAME
PROJECT FINANCING 1
0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE, ,.• 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
al 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 Vo claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim),which may be made any person,including the undersigned,and filed against the city,
bu; only where such claim arises out of the reliance of the ci including its officers and employees, upon the accuracy of the
information supplied to the city as a of this application.
C
8IeNATURE: . .z Z Z
/� DATE /
PRINT NAME: deg e t.K jc-'c/Z R CC/2
Bullet n#100-Januay 29,2016 Page 1 oh k:\Handouts\Permit Application
MECHANICAL PERMIT VALUE OF MECHANICAL WORK
$
Indicate how many of each
type of fixture to be installed or �located as part of this project.Do not include existing fixtures to remain.
AIR HAA DLING UNITS' FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSER i. HOODS(commercia)
BOILERS FURNACES HOT WATER TANKS(Gas(
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING PERMIT VALUE OF PLUMBING WORK
$
Indicate how many of each type of fixture to be installed or }-located as part of this project Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower Combo) LAVS(Hand Sinks) 1 TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTE S URINALS OTHER(Describe)
DRAINS SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(ititehen/utb, WATER HEATERS(Elect..)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$
EZIS^ING/PREVIOUS USE LOT SIZE(In Square Feet) =STING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
. Yes o No to Yes ❑ No
I —
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING P',•POSED TOTAL FOR OFFICE USE
BASEMENT -----
I r
s "
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COV2RED ENTRY
...............
DECK
GARAGE 0 CARPORT 0
OTHER(describe) f.---- _ - - -- `- _ _ ,,. _
Area Totals EXISTING POSED TOTAL .....
ESTIMATED SELLING PRICE$
#OF B DROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area is Construction ik of
square Feet Occupancy `' up(s) TFpe Stories Additional Information
IG :_ - ' . I -
�y
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVE 1 I NTS
ARA DESCRIPTION Area Occupancy c� up(s) Construction #)of
Square FeetType Stories Additional Information
TOTAL BUILDING` is
TENANT AREA ONLY f/3 112 5 }qe z .d. l
Bulletil #100—January 29,2016 Page 2 o k:\Handouts\Permit Application