19-104271 ` RECEIVED
PERMIT APPLICATION
CITY OF
SEP 0 5 2019 PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
Federal Way OF FEDE 253-835-2607 + FAX 253-835-2609 +permitcentel@cityoffederalway.com
UNITY DEl/ELO ME-
PERMIT NUMBER 7 9 _ / U 7A 7 / _ F to (-------------
///
• TARGET DATE
SITE ADDRESS SUITE/UNIT#
llfOJECT V111� ZONING ASSESSOR'S TAX/PARCEL N
3. o g / o y - q _D 3 a
�
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING AFIRE PREVENTION
NAME OF PROJECT M W V I___ifk--e---
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eI, 4-a{/Aj / rn.f e-( v( �l� FO t)f'/1 l O V/l GL I`er)-N
PROJECT DESCRIPTION
t etn) O e s 4(Y 1.n C'I v /�0� I,i d� io F
Detailed description o work to I
be included on this permit only ,� ��, e F1 oe�' F 'r 0 / nuf5 i k
re, I
__.. .- NAME i,, a \ t►rQ,\ vV LI`j p,\.71(C- �l C\^O C7 ' PRIMARY PHONE. __
� 'CG `` S
PROPERTY OWNER MAILING RFs ylU S G� E-MAIL
\\ �v. `3 2
CITY �- 1 ck 1 W (.1 STATN 2IP a\(6 O o 3
NAME Q 1� viA cov,gA-� C.� vt C)11 _ _..__ PHONE - -- ---
TO
ADD-�RESSp EMAIL
X. CONTRACTOR 2 CCZ) z 3 2 �'� \i.,)J�1
CIT `l W\1/4° * ` STATE v4 ZI� I f) FAX
WA STATE CONTRACTOR'S LICENSE# W ICl` EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
Y
NAME 111 c d / A` v A eki II PRIMARY PHONE
X
APPLICANT MAILIN2_ bbbES33 ^ Q\ AvS'\.0 EMAIL
CITY 4V 0 VV Qk1 ,^ STATEJ6 ZIP p t� FAX
NAME -'\ Y 'cA ' 10 ` PRIMARY PHONE a
PROJECT CONTACT �`M e C� w ZS 3 2-8Ck S3 Z C
X. (The individual to receive and MAILINGADDRESS_3Z0- n.� I\\ r � �\ I E-MAIL
respond to all correspondence g ` V ^J
concerning this application) CITY STATE ZIP _ FAX
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 he reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part o this application.
SIGNATURE: 1 A DATE
aelI0S12-i lI
PRINT NAME: /IN" h VV1 C c P\ w c^i‘1 \1
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 offacture 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(cas)
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(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) '
,',0c011?EL_QQR_.. ._, '
. . y .. . ^ .
COVERED ENTRY
DECK ., . .
.... n....s.. ........•.........4 ..N --- 4,.. A a.../.i..F(..%v 4 ... '.yw' ,r+f{cw..is J.=#.++:•/+..:1+nk.M. �'e,.r........,.. ...s
GARAGE' El CARPORT 0
. QT 1r0(describe) ( r -,
Ory{ti i
Area Totals EXISTING PROPOSED TOTAL
;.:: ::. *r.wwlitir ES or ' :.. . .:. . .::',;._.;;:,,,:..-4
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction of Additional Information
Square FeetType Stories
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
•t .!*n �A,' .•ii`. :ti.,.. r''-1 ;: tt}4,•`'.kitei`.'*.',A.: i?-
,s:,:" ,. .i.: 'µ4,1'n,1, - _ :. '.'t' .t44+:it{u ,i,-y,1..• . ,;, ;,,,,4i+4,;,,.,:,%,:. ;
.. •
DI
TOTALINCs
TENANT AREA ONLY
.. +t'
PROJECT AREA,ONLY - .
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application