19-102371 ` RECEIVED
CITY OF ,�— t1 PERMIT APPLICATION
MAY 15 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
(-----------)
PERMIT NUMBER J _ / 0 4 3 7 L _ Ep
TARGET DATE
SITE ADDRESS SUITE/UNIT#
$lg SW 32-4%-fz , St
PROJECT VALUATION ZONING ASSESSOR'S TAR/PARCEL#
$ (9i000 9 A (0 1 0 - A 0 5 0
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING RE PREVENTION
NAME OF PROJECT S1^WI-64y
PROJECT DESCRIPTION -,e ,..f/IS-lea,Slea, -t2I l Sd,Aore l r,' ✓1 S''S r✓f
Detailed description of work to
be included on this permit•
only
41
_ _-
NAME PRIMARY PHONE �j
�e74 Q'r
, i�61/7v 2o 6- ? g 6 ctZ
PROPERTY OWNER MAILING ADDRESS fj E-MAIL
S/ Sm✓32_6 . S- fie fed /1-&'7, T4•r-cir
CITY STATE ZIP
Te-. 2e0frig 1 14.,07 7 _ lti/- 84Z 3
NAME PHONE
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
NAME PRIMARY PHONE
i' ' .4',V-Z .,--7.,--7 u
APPLICANT MAILING ADDRESS E-MAIL
S/r 51^✓32--dr S-
CITY STATE ZIP FAX
j�.oldy 1 A/ f," k✓A- Sdr-o 1— _
NAME PRIMARY PHONE
PROJECT CONTACT 'f?Z', ,'-K/1/4y(f 727 x-3 1.. -S L
(The individual to receive and MAILING ADDRESS '7 E-MAI
respond to all correspondence I D Ste, S� �t
concerning this application) CITY STATE ZIP FAX
le'e,d0/ /A/A/7 !ti, 9(0 l i
NAME
PROJECT FINANCING �f�H `��� WNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27095)
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 supplied to the city as a part of this application.
SIGNATURE: 71409
12DATE 01-//c7/7`7
PRINT NAME: 7aye /..?.',11-&.,-, r..,
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(Commerotnl)
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. P• 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 VACU BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utility) W' ' R HEATERS(Eicctnc)
HOSE BIBBS SUMPS ASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
ii, CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER P VEYOR VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) E:STING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Cl.Yes ❑ No ❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXIST It PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OTHER(describe)
Area Totals EXISTING PROPOSED TOTAL ---------- ---'- ---_ - --- -
*"NEW HOMES ONLY"
ESTIMATED SELLING PRIC $ #OF BEDROOMS
COMMERCIAL— W/ADDITION
AREA DESCRIPTIO r Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
ADDITIO
COMMERC —REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Square Feet Occupancy Group(s) Type Stories Additional Information
TOTAL F'tiILOTPtO
TENANT AREA ONLY
PROJEcr AREA CM.? .
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application