19-104240 RECEIVED
,..., _A. PERMIT APPLICATION
CITY OF
Federal Way
SEP 0 4 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607+ FAX 253-835-2609+permitcenteracihroffederalwav.com
COMMUNE'-y D RALOPMEN7'
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PERMIT NUMBER / q'- / o Vdi Vo - FP
TARGET DATE
SITE ADDRESS SUITE/UNIT#
3`1 O 1-- .1_\ ) e S(,c)
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 411 Ck 3 0 V 0 p - d U \5 O
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING si FIRE PREVENTION
NAME OF PROJECT *--r_k NiNi`'f.it'i-
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PROJECT DESCRIPTION
Detailed description of work to 'AP'Q 1\,.'U ��t5 i' PXt..vk •
be included on this permit only
NAME PRIMARY PHONE
`l/,1.d� s'
� Cc, 1 503 -.141 3s-17
PROPERTY OWNER MAILING ADDRESS om` E-MAIL
/P,C 0 — S E '2 -L e rrOe...t• "v1'te @ 1Cnes,er,
CITY STATE ZIP
'vegc,,A. Dv.... cA`120Z CO w
NAME ( (} PHONE
MAILING ADDRESS\-\:\
I n1 C t �� ,\ E-MAIL
CONTRACTOR `` "`t ` � G\' tit�
CIT7 �O �� STATE ZIP FAX
ogo)0 01'11 Q
WA STATE CONT R'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE N
NAME PRIMARY PHONE
V-tiOt.Nk Nro01'AI\ c ./ tut 1v.c 2/0C, 5.1 c `Ck( 7
APPLICANT MAILIN E
g6 -
CITY....,�, I
� \ W� ZI CkVek 7 -SIC)- 5S 1913
6
NAME PRIMARY PHONE
PROJECT CONTACT .Q V's+.\�p 20 -'L31k-S10 0
(The individual to receive and MAILING ADDRESS E-`MAAIIN\
respond to all correspondence (o``Svi "I `br "�!)�Sola \�c?X0.\Ci�1-mots ,CO`A
concerning this application) CITY ��� +\C I Za ZIP t3e `�Ax
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 of this application. i Q
SIGNATURE: DATE —/' ` \
PRINT NAME: , ✓v•\0.77
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(Caa)
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/Shover Combo) LAVS(Hand Sulks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(wtonen/Unbty( WATER HEATERS(Elctnc)
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
BASEMENT
FIRST FLOOR(or Mobile Home)
SECOND FLOOR.
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER(describe)
EXISTING PROPOSED TOTAL --..-
Area Totals
;r*NEW HOMES AAVZY"s
ESTIMATED SELLING PRICE$ #OF BEDROOMS _
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s) Construction ll of Additional Information
Square FeetType Stories
r - -
NNW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in Occupancy Group(s) Construction # of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJaCT AREA ONLY \ 0(2 0t Kt\
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application