19-103869 e -. 4k RECEIVED
�°F 1111 AUG 1 z 2019 PERMIT APPLICATION
C
Federal Way ay PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
(+ 1 253-835-2607+FAX 253-835-2609+permitcenteraicitvoffederalway.corn
CITY RAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER I 91 I 0 ✓ F ", 9- _ F_ _ _ _ TARGET DATE Pl/ii
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SITE ADDRESS SUITE/UNIT#
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PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
TYPE OF PERMIT ❑BUILDING ❑ PLUMBING ❑ MECHANICAL ❑DEMOLITION ❑ ENGINEERINGFIRE PREVENTION
NAME OF PROJECT hes rc ,Les"C.
PROJECT DESCRIPTION
Detailed description of work to kr"/e2,. ., L,6'i/;*e 4/�, '-'i `zri < / C'Vit'wl-/- S5�/"1
be included on this permit only r �/
NAME / �/J RIMARY PHONE
PROPERTY OWNER 1 +Min•r ✓p?)O4 // 6 a/if(fE /97. lit c Jti{!/I- , _S-T3'7,1,1-2 7L/
MAILING ADDRESS L / E-MAIL. ,,/ �
9c �'c 4 f sT /Jill 4144/Xe P. 1071X 4A jT-0
CITY STATE ZIT
Z.-4M ere/ 7AA 9-0'99
NAME id/`, S6-c//1(44.---1/7/ ull,////� G- PHONE -/e..2)Ci
MAILING ADDDRECSSS,/ E-MAIL /, /
CONTRACTOR c '/ i"</Ct-�G aid 1,iSG1M/i4"��,/;74/.C`/'7
crrx. STATE Z FAX l 2 /��' 3Gel l/ -24/6,-2-
WA NT 1 #SE M DATE FEDERAL WAY BUSINESS
SINESS LICENSE S
e/ S�,�J -/b / / ' (
NAME PRIMARY PHO E
�G /fG7/7lSat%,g)ez-,
APPLICANT MAILING ADDRE E MAD
S '/ N"/�� I �13�w> cG��J�yrl//CfXi
CITY Z FAX
Ciy�r)� iv,'? 1�s76 3et-9»j- 24;D-
NAME PRIMARY PHONE
PROJECT CONTACT _c1/l9• aS CIve,
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING '❑ 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 claims,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: /-:„-:-...----',..e.0. DATE )24?
PRINT NAME: /c(/ /' Y /7/+ '
Bulletin#100-January 29,2016 Page 1 of 2 k:',Handouts\Pelmit Application
•
VALUE OF MECHANICAL WORK
MECHANICAL 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.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial)
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 Titb/Sbower Combo) LAVS(HandSmksp TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Unhty) WATER HEATERS(Etewu)
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
RAM
FIRST FLOOR(or Mobile Home)
'sI CoZ b rr.koR.. ` ;
COVERED ENTRY
GARAGE ❑ CARPORT OftaeideLie:Mbei‘
.a-. EXISTING PROPOSED TOTAL
Area Totals
1 WIOR o
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Gronp(s) Construction #of Additional Information
Square Feet Type Stories
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction Sof Additional Information
Square FeetType Stories
TENANT AREA ONLY /67/ 79C7
/1 ^* ^. l� ' ,
Bulletin#100—January 29,2016 Page 2 of 2 k:'Handouts\Permit Application