19-104328 „„,...4.... RECEIVED PERMIT APPLICATION
CITY OF
Federal WaySEP n0
2PERMIT CENTER+33325 8th Avenue South + Federal Way,WA 98003-6325
i� 253-835-2607 + FAX 253-835-2609 +permitcentertacityoffederalway.com
CITY COMMUNITY FEDERAL WAY
PERMIT NUMBER k 1 _ I OP ENT g _ F ? ( � .
q z TARGET DATE S�(�• 1
SITE ADDRESS 1 ZZ S ✓ Cf � SUITE/UNIT#
. ---. F k ° x'003 !'
PROJECT VALUATION ZONING 1 ASSESSOR'S AX/PARCEL#
$ 3oco. co I ( y v (1 0 _ C} O Z a
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING fYS FIRE PREVENTION
NAME OF PROJECT Ev c C eve -Pt l s-k-1,Q-'2.C S
PROJECT DESCRIPTION
tins-40.M`� e.V0 -'!a Sef..er- RAI. ill ,Qic .0; Alr.rv+')'
Detailed description of work to
be included on this permit only
NAME — PRIMARY PHONE
�rt -i- kA cs•
PROPERTY OWNER MAIL ADDRESS E-MAIL
3 41 G f4.' lAt _ S •
CITY STATE ZIP
WA' oto' 3 _
` AM. E PHONE
' ADDRESS E-MAIL
CONTRACTOR C 00 Sw 131'^ SA. IL 2 00
CITY STATE ZIP FAX
fit3-0-6.rN to A `V6 LS 1
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
l3�C.V4 CC-1 9 5$131) _ / /
NAME PRIMARY PHONE
,..+.:Lc x Se-t., .;e,ISCO P11 w,ie cAe-c4r:c•tA
MAILING ADDRESS E-MAIL
APPLICANT 12-60 2.0(0) 5c1 — 9 0& (D .
GOO SvJ 1 341„ 5�-
cgr STATE ZIP FAX
IVev,�-w1 (AA- CATS-05-1
NAME PRIMARY PHONE
PROJECT CONTACT -Oa`^,-r_k S-e et#wtlSooe_c:-(t.v-,.e el e c_4-y;c-c°""'
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence Cni e, StA.-) (3 i-.• Sk 4202) (ZCG) 5G1 -cot.TIG
concerning this application) CITY STATE ZIP FAX
tel^le T^ (M4 Ok Sc°S i •
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 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: DATE c^of- /10 / 2'0 l -
PRINT NAM=1.......-- .',..4.-- \ )C t
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(commerc59 -
BOILERS FURNACES '‘ HOT WATER TANKS(cas)
COMPRESSORS GAS LOG SETS . JJEFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES -
r 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(Kitchen/utility) 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 ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
'DBQK z
. ;..,...:
.s .. ww++-IM,.•lvi':+.+u✓+►,...,Yv,.,r'. .,.,,.Kw,i'�' t .,.,, '.'
GARAGE ❑ CARPORT ❑
QTI (t'(ziescrr7ai.• r •
' ' t `s ,,;.: ., — -- —
Area Totals EXISTING PROPOSED TOTAL
' ,v, ✓ ,iti•. ',»1VEti;►'HOMES`ela rt.''., ,."•'.- .4i, ,,i?.
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
,, ,.'9.NE%BUILDING,,:"'..,`2:4::,:', .:164;,,,--",;r:.;;;.,-.•'-.:.'-,•:•4.,:,•,;,,,-;?.` •", , .. ,, ' --,tr
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
.,,,,,•,, ,-1,,,,•:1,4!,,,i',*7;144 '!.'•.`�x+:•; ,•,'t ",<< .,r,:, '*,: •, 4'; a. - 5,,. ',.•s '74,.,'„ , „ :,,
TOTAL tDING •
TENANT AREA ONLY
kOJECT AREAD46: +t'' .• ., , n •>'a r
Bulletin#100–January 29,2016 Page 2 of 2 k:\I-landouts\Permit Application