19-102430 RECEIVED
__ _A,.. MAY 1 7 2019 PERMIT APPLICATION
CITY OF
Federal 111/a err/` "`�Al-t:JAY PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Y cc��i+1i1 +i Y u Vt _c�,., ,,7? 253-835-2607+FAX 253-835-2609+permitcenteracitvofederalwav.com
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PERMIT NUMBER J /q _ � 0y3 (2 _ F70TARGET DATESITE ADDRESS VSUITE/UNIT 0
2 5 o5 So,>,kh �2$C) ON 'ST S%0
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING f{7'FIRE PREVENTION
NAME OF PROJECT 9 vola sov4.4. QR..-gym . Oc Y--.0�
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PROJECT DESCRIPTION pp�� �� 1�
Detailed description of work to 'SV F'�
'j • &\i flt 'ems Sle.l' horn /Sic- baS 4-to, vYtt
' be included on this permit only Skec.,be_s •
-- -- --- NAME --- PRIMARY PHONE -
t it\ v CM.v•cUZ.g VtA CQiNr.t- 1._1--e- 2n6 57-5 1 ci62
PROPERTY OWNER MAILING ADDRESS E-MAIL
2 5 v 5 S 32,p t3. 'ST �kc 1 s hQ'Frevick e►1a cl►i,.c.a►c
CITY STATE ZIP c\
D yst,
'-Q. CU\ WC1041 SPI
NAME PHONE
.-- --c-.4:70 o. Al Ac Pi, SuY,k�MAS `7426 SE'S 1ak2
MAILING ADDRESS E-MAIL �^
CONTRACTOR 436 k "Fr� n C'Av� c.V.`1she�crevlakasofvcrivt
CITY �wkWA\o. STATE Zs� 4
� q '105515(4 16d
WA STATE CONTRACTOR'S LICENSE• EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE r
.okkt..RS 1-242 O S 3 i t o i 20 1°1-S4 -105 635 -to'41
Te' -
NAME Ttr'owk0. Atovr SvJerv152o6 S'.S t q¢2
APPLICANT MAILING ADDRESS 1 E-MAIL
x/1%6 Zt�VUe) ett:%IQ— t k1r4 Sh @E+owlo,4o C111;Ldr►
CITY Tv ,It\o\ STATE
A ZIRcb\L34 FAX
4 -5 416 9
NAMEPRIMARY?HONE
PROJECT CONTACT `S Y`1 t14,e S Z,6 4'. S 1 A(2
(The individual to receive and MAILING ADDRESS y M ` E-MAIL
respond to all correspondence 4%6\ �tk __J �tV e_ G.ho1y1^Qc ,�,�,�kp�\�in,,cer�
concerning this application) CITY STAT ZIP FAX
.-.11.4.4.04lo1/4 WR 0\4%4' 206 S"+S 4,16 Cl
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 rell•nce of the city, including its officers and employees, upon the accuracy of the
information supplied to the a part o is ••lication
SIGNATURE: / DATE 1-4 — \ C\
PRINT NAME: Gil••4S '`1RU14es
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(commer.,d)
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 offixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower LAVS(Hand TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(K trhen/Uh ty) WATER HEATERS(Eieet„e)
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 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT - • . _ —
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(itetcribe) ' ..
EXISTING PROPOSED TOTAL ......_....._ ........—..
Area Totals
**,NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
New Run niwo
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area is Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PItOJCC?AREA ONLY
Bulletin#100–January 29,2016 Page 2 of 2 k:\Handouts\Pennit Application