19-102852 ' RECEIVED
CITY OF „.....46,..... PERMIT APPLICATION
Federal Way JUN 12 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(acitvoffederalway.com
CITY CF
AY
COMMUNITY DEVELOPMENT
PERMIT NUMBER I q - Lo 2 S_5__7— - F A ,4-
TARGET DATE Ali/4-
SITE ADDRESS SUITE/UNIT#
X0to 5 1 3 54 ti" 34-. Feria t.o.Q LOCA-41 t`3 19 9.80'-3 5146 . a
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 1a o3 4-t-, Cori,.„,. . 5 a t 0 3 - a o I d
TYPE OF PERMIT D BUILDING ❑ PLUMBING ❑ MECHANICAL Cl DEMOLITION Cl ENGINEERING lErFIRE PREVENTION
NAME OF PROJECT t o ciAn S h 0 re. 1-I eat-ea 5tbra-el C r ' b {
A3
PROJECT DESCRIPTION R i-e S fi «dprott 3vitt
,,�,.PitAt, d `G J
Detailed description of work to µtb rnlx,}h C 6 grin W'. 600C.►+MY h r lot !3'. �J-p
4 13 Yi r IULv.
be included on this permit only OeAt4, ted , U
NAME PRIMARY PHONE
1-- A/5 ZnvesturY5 Lt.0
PROPERTY OWNER MAILING ADDRESS E-MAIL
Po [3o1C- 1 t 1.
CITY STATE ZIP
p•wburn wf1 I8O' I
NANCE NoRtt+wEr F►2.E. SISI S 2ob1-4-a•"7--yo),
MAILING ADDRESS E-MAIL
CONTRACTOR a a-1-0 L4-CD 8 3 rol Avg_ J l',) Korea+'a`�n w+S resor"►�5
CITY STATE IF FAX (�yy1
Kewvi-- Loa q803 c), Uip/3-3-L35D
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE a
N oR-m Fj q a.$eA, DX_ ao / 2-O
NAME PRIMARY PHONE
N er(k FYI SU(J -vsa Sot, m•�- a-3,
APPLICANT
MAILING ADDRESS E-MAIL
r9-.X945 83vd- Avt. 5 �tdy D rcartzu--.0 -
p _ �rA a �0 3 . FAX c."4",
z(, // PRIMARY PHONE
�,,1tt Wl�� L fat. ��a �50�{
PROJECT CONTACT NAME Kt4"t-1V I b Q.e - -GY N/Yfetkai Tl I'e 5 /71.e.44, atrIo 1" .1"60?.
MAXI(The individual to receive and _O-a(.011'
�1ADDRESS3 ,1 (� 1 U E-MAIL�r� (e
respond to all correspondence ``►►"''JJ O ro J/ Sh15}CvW� -
concerning this application) CITY ,6T Wn E ZIP n FAX tJ LOW\
I� ^ 2-Crt9 l'ia.T50).
PROJECT FINANCING NAME Na 1 Tp pyt,{Z ILNtlLt-A ,i,6 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best
of my knowledge, the information submitted in support of this permit application is true and correct.I certify that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorised by the issuance of a permit.I understand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation and defense of such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
SIGNATURE: <M ld. "'"W""O WofikaiSt,`( 4 bySt44,0 DATE 64 .L L.46
PRINT NAME: KQt't'Li O`2t0.Y FYr NOY 1Wta YQ.. Sit6tevrLS
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
a
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type of fixture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS)Comm<raal)
BOILERS FURNACES HOT WATER TANKS)G.$)
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)Nana Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS)KItchen/Uttny) WATER HEATERS(E1<ctnc)
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 UPPRESSION SYSTEM?
Nv at0 l8131 �/ i'd"te ❑Yes ¢� No Yes ❑ No
l91.44,20RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY GARAGE ❑ CARPORT 0
Area Totals �o I�Ib$ND TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Mal. Occupancy Groups) MEM Stories Additional Information
Is`",.ntr 40; 4l 447.s54t p)2 _+ .. -•* '. ,,
044.4.4
.tl'=': .�i;i'�i.� ..�.kWHAsti ..1.^ ._ +Ai'':
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION rigEll Occupancy Group(s) MEM
#°f Additional Information
gg Stories
`d, .�-:iY'd '"' ,._ "'•og` .. .['N- r,. ,^•n .. .:"�r`-
TENANT AREA ONLY
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