11-101648 ''48 IIIL _I_ L _I_ (., IN
an,OF--.
Federal Way PERM J J F CO ME PL DE E FP )
COMMUNITY DEVELOPMENT SERVICES AP P LI CA T v
253-635-2607•FAX 253-835-2609
www ahaoffederulwutt corn �/g
APR 2 9 90,1 $11/143 1
SITE ADDRESS I F FEDERAL WAY SUITE/UNIT«
505 5. 33-th , 5646 CDS /00
eP7ROJECVALUATION ZONING ASSESSOR'S TAX/PARCEL N
_ COVv
TYPE OF PERMIT ❑BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING AIRE PREVENTION
NAME OF PROJECT
(Tenant Name/Homeowner Last Name) YAINn\ ^ nr)inolick.
PROJECT DESCRIPTION Ma C O ) -c l Y' pr I Y)J l e r
Detailed description of work to J 1 C., f
be included on this permit only (�p J o/�iy 1n /'7 -fl r.P cprin i1 er hPacs
/� ( LI��I 1, / ! PRIMARY PHONE
PROPERTY OWNER 5P j�era/ 14/461/GeADg ewdd er Pl y S..'i/ 200E-MAIL
bake 9 A VMA ZIP
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rou�r� dire k�i -�-tX1'1, �r>c 712.6... .48/.
CONTRACTOR •� G JX 'Z1 ,eSSICa CfoLonfp coin
X11 Crew 1
STATZ IP
LCA 2'78082 42s•yh/1_6,9s
01I R'S 044 LL 7PTR/AALON D/ T3 /9 EieLW QSI�/ BL0NPHONE
noWrl fire Pmrection, l rlc 1125•ugl•14214
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APPLICANT j 2113 e�6tcoLe ro onip.(OJ
CITY
1\ Creel STATE
88052 1.42G4g1.810c1S
PROJECT CONTACT /�,, PHONE Q' I�
(The individual to receive andDmseicgW 1DY1 42G• �1 7CAv�
respond to all correspondence MAILING ADDRESS MAD
concerning this application) }5SsICA 'C Crown+CQbI
CITY STATE ZIP ty�
ALTERNATE CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME
0 OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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 • city as a part of this application. /
Alif
SIGNATURE: ,211 • IA ._ /DATE 7.28'11
PRINT Air Al a All
Bulletin#100-January 1,2011 Page 1 of 3 k:\Handouts\Permit Application
• •
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VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
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 OUTLLIb OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS)commer i 1)
BOILERS FURNACES HOT WATER TANKS)a.)
COMPRESSORS GAS LOG SKIS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
i.�.3� ;"sky '4'�"�3�i�". ''. ;"%�,'"".E•�''.X�ys,. STS t
�� �' �.� ✓,.i'�i,t� ti; " �� r'%
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 nib/Shower Combo) LAVS(HandStnk.) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kttohen/utll¢y) WATER HEATERS(electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$__
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
/Yes❑ No ❑Yes 0 No
.[ L��ww,,i 3 y •,@k ayF'
•, � lk iytR'� L�sf[ �)unlA t,�M YI ry<� �F' � �� ���,R.k '���� �� •2�..�.. i�:3 ,
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR '
COVERED ENTRY
DECK
GARAGE 0 CARPORT 0
OSTING neOroesD TOTAL
- - --
s
Area Totals
""NEW HOMES ONLY"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
;1;1f„. y; ,}r, iE {, ,,, 91.. aW �.n4, 44•< ru; : _r ., ♦Y N
: r em /�
u, i. rr'xr ,i3r.,r� s✓ � N�',`n .�rf7s'�, K.,wiw •,} 3 3'• ••
- ; 1 'JAM!' � 3. Y a�t�
AREA DESCRIPTION `mei Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
ADDITION
1;74;i„;, ' fir'.-, y �'•., , ,:d,. .. �,.�- ....
�w
AREA DESCRIPTION
Area Occupancy Group(s) Construction #of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
Piton=/ m oNLY
Bulletin#100-January 1,2011 Page 2 of 3 k:U-IandoutsTennit Application