15-105540 C� A • RECEIVED PERMI. APPLICATION
Federal Way
OCT 3 0 2015 4,itt
424
agrrp AY W
PERMIT NUMBER l 3 — i o '77 - h ' "
TARGET DATE /
SITE ADDRESS SUITE/UNIT S
al 03 SIJ. j1- sp-f- - 2 -18-7 Y
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
$ 5/WO 1 34 2 1 7 - 0 6 20
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING WIRE PREVENTION
NAME OF PROJECT ` ���te,e/p� ,�/`,?C0 I
PROJECT DESCRIPTION ia�`G/�"`.'I- ` / LG-e;�C .(�J ig✓�C ,S✓/�ri1/ i Sii/e-/Y)
Detailed description of work to 6'") a-61/1 /}6 5( 516-lam
be included on this permit only /
NAM '` PRIMARY PHONE
PROPERTY OWNER 4# o/ a53-- g, _ qqy /
MAILING ADDRESS i E-MAIL
cq/a9 51d 3,3ze
CIT1 2k / W STATE ZIP
NAMPHONE
iTi Ch;e i e'- L/76.-5 2Z-/Tc/
MAILING ADDRESS/, �'�` / n E-MAIL I ! s
CONTRACTOR -71 ,1 /5 ' P/a /vim. Ireir nLtolam /I're.
CITY �S E 726.2_ FAX �1t �,r
rriCr i C.f�1l f GOrvt
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE k
Fie_ -q3Sse.. 4/ / 30/ 17 14-99-/(272.-0)-1?"-
NAME PRIMARY PHONE
t ca0V a5 all9de.
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME , PRIMARY PHONE
PROJECT CONTACT er /ede '
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence 7106'1 /`5 /' if-t: r1/6-"-
concerning this application) CITY STATE FAX
W11/19101 611A
PROJECT FINANCING NAME 7��'1 OWNER-FINANCED
Required value of$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. Q
SIGNATURE: Vi/41 . /'4 DATE gd`' /5
PRINT NAME: 'AI 1. Alfir L.(
Bulletin#100-January 1,2013 Page 1 of 3 k:\Handouts\Perinit Application
IIII S
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
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 OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commeraal)
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 snilrs) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kxtchen/Uhhty) WATER HEATERS(Electro)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
C7 Litz LU ) $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
C, `o` t r l 1"5-7 G 2 'es ❑ No Yes n No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home) --
COVERED ENTRY
GARAGE 0 CARPORT 0
yam`<r ane , iiir ,' ,';' 4 _...........-..__. .._ —
Area Totals °m° rauroanu 'n'"`
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ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
of
AREA DESCRIPTIONIMMI Occupancy Group(s) Construction St es Additional Information
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ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTIONPINMI Occupancy Groups) Construction St ries Additional Information
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Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application