19-103772 ' J ► PERMIT APPLICATION
CITY OF �..,or AUti c b 1019
Federal Way PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Cr1?OF FEDERAL WAY > 253-835-2607+FAX 253-835-2609 +permitcenter( cityoffederalway.com
COMMUNfiY DEVELOPMENT
1
PERMIT NUMBER I 9 _ I 0 3 '1 / 2 _ F TARGET DATE /
SITE ADDRESS SUITE/UNIT k
Hoo S 3 ,0 ,3r , re_d / 14Ai (4/q 93003
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 0
$ //C600, 00 o S 2 1 0 14 - 7 si1 iz 1
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING K FIRE PREVENTION
NAME OF PROJECT ESA C I
PROJECT DESCRIPTION " /cu/y G A�> 1\4/L, 7v r K,'SA;ly cd.,-- Sy.SA-/-•
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER xfe-n cioj �,y kale,' C e., (' v)- 34/r- /640
MAILING ADDRESS E-MAIL
11 5 9 s N Corlrl„n,'1-y hal.- ,,► 1$/ter'
CITY �r 1 O 14c....
� STATE
C. ZIP 71.2'. 7i F}
ONE
NAME SCC C. r1 C.4 /-11 P1 s1427/ 3/1 ''2 5?
MAILING ADDRESS E-MAIL
CONTRACTOR 3°/R/ M`Y[ /he_ fleN,crY Ctid/.5e4Ccot_Cr)til
CITY STATE ZIP FAX
PI/CPC,1 - IAA Cr s 01 ('1.0-3I7- X 6/
WA STATE CONTRACTOR'S CENSEEXPIRATION DATE FEDERAL WAY BUSINESS LICENSE M
SGA C/'J � Y9���� 3 / D
NAME
PRIMARY PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAMEP MARY PHONE
PROJECT CONTACT 14')dy /oy 7`,A 5)-3i; - S'.?S
(The individual to receive and MAILING ADDRESS �/C�y� /TA E-MAIL
respond to all correspondence
SO/y /1 �' r/ .��,i G 4// H (i,,r
concerning this application) CITYSTATE ZIP FAX
L i'ent_i-i' 4,1 1 S(201 rix S-1 -W- l'?G 1
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 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 c •im),which may be made by any person, including the undersigned,and filed against the city,
but only where such claim aris of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the cit • • part of this application.
SIGNATURE: )DATE 7- 2 j /
PRINT NAME: / a n dp'f L0 L.,e,y
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
•
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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)Commerc.al)
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 Tub/shower combo) LAVS(Hand sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS)K,uhen/Utddy) WATER HEATERS(Eormr)
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
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FIRST FLOOR(or Mobile Home)
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COVERED ENTRY
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GARAGE 0 CARPORT 0
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EXISTING PROPOSED TOTAL
Area Totals wry
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION SEMI Occupancy Groups) Construction Stories Additional Information
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Construction #of
AREA DESCRIPTION MEM Occupancy Group(s) a Stories Additional Information
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TENANT AREA ONLY
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Bulletin#100—January 29,2016 Page 2 of 2 k:\I`Iandouts\Permit Application