19-104104 RECEIVED PERMIT APPLICATION
CITY OF
AUG 2 6 2019 PERMIT CENTER+33325 8th Avenue South+ Federal Way,WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY
Y
COMMUNITY DEEF VELORAL P ENT
PERMIT NUMBER _ / // �`/ 0 e _ Fp
/ (/ TARGET DATE
SITE ADDR.EW SUITE/UNIT N
k) � J 357
14 �f a);I8-,
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 70` by a — - — —
TYPE OF PERMIT ❑f\J
BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING I E PREVENTION
NAME OF PROJECT c' +k 6Lthre 14ea,+e, -CriTYP (AQ._
Fire alcxx S sfem
t[
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME p-w S /1 PRIMARY PHONE i--
PROPERTY OWNER MAILING DRESS (\� E-MAIL
CITY STATE ZIP
bNAME 5vv (,)IA PPE /_
MAILING E-MAIL l/3 a/1 GA i� 1 Y`C1 V�y �. I ��
CONTRACTOR I (3' o(Ho-nd y—ve .lartne a{e l erofer4-y5av1ce5.U�
CITY ST`/`COl ! la (/) ZIP ^� FAX
WA STATE CONTRACTOR'S LICENSE# ,rr((��,, EXPIRATIONPIDATE FEDERAL WAY BUSINESS LICENSE#
NAME � - PRIMARY PHONE
APPLICANT. MAILING ADORES E-MAIL
CITY STATE ZIP FAX
NAME _-- PRIMARY PHONE
PROJECT CONTACT
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING Cl OWNER-FINANCED
When value is$5,000 or more MAILING ADD S C TATE IP 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.
4111 Or
SIGNATURE: DATE £ 4111
O
PRINT NAME: p 14 .art /I 9 ILA
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(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 Tub/Shower Combo) LAVS(Fiend Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS '
DRINKING FOUNTAINS INKS(Kitchen/Utlity) WATER HEATERS(Electric),:
HOSE BIBBS S IPS WASHING MACHINES : TOTAL FIXTURES
•
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR ' VALUE OF EXISTING IMPROVEMENTS
f
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes ❑ No f' ❑Yes ❑ No
r'
r
i
RESIDENTIAL - NEW OR ADDITION ;'•
AREA DESCRIPTION(in square feet) EXISTING PRO••SED 2(0TAL FOR OFFICE USE
•}', ..
: . ,, . . '.,•.a,i•,�''y"i :s•••".r r....,,.. •,.ay�,o" ,.f ,., `. i.'xY"" "a�•7w s„ •-�Y.+.., .1 n.
~1jd'4ty I .x..c',tj.i,a
/
FIRST FLO4�O/R� (or Mobile Home)
COVERED ENTRY
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..w���...;f.Y•ww-.a'..�.,,..,,,-..».,lr' ,t•anM.T4;+:w£,r•f,..:.. . - •. .a„s .4 .n...»..+w• ..... { .
GARAGE
0 \,CARPORT 0
EXISTING PROPOSED T AL
Area Totals
' . ':;,-/iii:# .irk 4MES'olet*' y t. '2,,4
ESTIMATED SELLING PRICE$_- # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
" > i • � ,, .�, i
>
--..?:; ti"5...•..plm.11DILI� wi '^ :444Je`arx�>w.,A ,. ;; t«,4✓ ".rt"w..k , , -. jr s•t" ..-•�.�, „J4�,'''y. :i,„i%%'V;, ��r. . �.J,.�
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
a ,: f? p a F: r t 'c„ I >.,, x• R, •.^: rr ey:y:' .,v,410,:',‘"r„
IQTAL BtILD G .f,-.. '''1 :.iF.a�.frs'4=.. .,. t:,' ,I= 1a, c
.
TENANT AREA ONLY
.,i,*4.r.,..?.
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ar"r,•. ,•r�F , , ,it/
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'PROJECT AREA ONLY , ''
a _.,.rr:R ... .
Bulletin#100—January 29,2016 Page 2 of 2 k:\llandouts\Permit Application