19-104324 RECEIVED
CITY
10 2019 PERMIT APPLICATION
Federal Way SEP
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER i
1 _ ` 09 3 Z _ frp pith._
TARGET DATE
tit v? PNYNcAi TH APy
SITE ADDRESS SUITE/UNIT#
3 al 2.,'1 We.y ev✓ h ck,u(. Err \A/x( : LA;4t l 60 O oa
PROJECT VALUATION ' ZONING A OR'S TAX/PARCEL S
$ 33bO. ° 1 L """ - a2 a- 0
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING leFIRE PREVENTION
NAME OF PROJECT l. v P Fhy ;t 4 The p
Ft Pe A1CAA,YY TL , 2elc.)c� .i-e� 1. ,noil.F.od-h•ov\ atViLe- �vJ.
PROJECT DESCRIPTION
Detailed description of work to I n.5 t- --Q a a_A.eLi IA:vvA-1v O h fi U-h b� ek e V i ce s•-k17evUNA d,e,
be included on this permit only
(>1429-0\- eAW-Ol.A-Ay--r ...trt-LY P P 5rc.a.l11.NAME PRIMARY PHONE
PROPERTY OWNER C.I 0 /a v1d 0✓'e,1e" (`•'I vel ry X - (0 , )o(p 244. 42-4,t)
MAILING RESS E-MAIL
61 On 3\V 3\V 1(1)th 5 S f e. ( 0T) C a i2 Z.pAN aov ,c-,
7'evT D11. �T gsos tar e r
NAME PHONE
Nor4-in,we 6 re SvG-►,„.o 1[xp lea •7-SoO,
MAILING ADDRESS E-MAIL
CONTRACTOR a1.p45 $3rd /kv- ,t � w �►�
. S_ Pd , O Koreot-roDnA•resyst .
CITY eY..r STATE1 'I' b 3�. FAX
aot, "77a •7 SbL{
WA STATE CONTRACTOR'S LICENSE k EXPIRATION DATE FEDERAL WAT BUSINESS LICENSE M
No2rN FS11hMS oe / to ia2c4 lo - 1,01 Lt•y1 •o-17 • 3L
NAME PRIMARY PHONE
t.-.1y12ruwes- rzQ-t. Sysr /ViLt t 0Rear- aap1-4-a• da.
APPLICANT MAILING ADDRESS E-MAIL
a Lo -I 5 z. r-ec P'v-e, co 12?-c.o D I<o,^eu r-.)r+ A(51.351ert41,..
CITY STATE ZIP FAX LVVYI
K..LA,t- wq 1 a-as amp 1-a-"7-so4
NAME • PRIMARY PHONE ---
PROJECT CONTACT V-'T►��11.l,. (PR-.A,r yhvt pi'Fi"-4 Si. - Ace 241, 1-3-g.-7-5bl,
respond
individual r receive and MAILING_ADDRESS3 S ,� ic.ore y
respond to all correspondence �{'� O D Kor�.rZ n t+-��•rt S 5 Kau>
concerning this application) CITY , STATE ZIP FAX L.1-4.1_.I - t' L3F? CI V3-1-- aol. ---4.-;51.),--/
PROJECT FINANCING NAME I-- OT TD otA-e, K-1 .) 1 E, 0 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 authorised 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 authorised 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.
1
_IJ- ' n ��) r, 5v1� DATE (r:c't0- 2 D
8IGNATURE:`�(�t� (�GCQ.f'�2i �6Y 1vaY�� J� "1
PRINT NAME: K A1\ b.Q m. (!up__ b ,S6rs M S
Bulletin#100-January 1,2013 Page 1 of 3 k:U-Iandouts\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(Descnbe)
AIR CONDITIONER FIREPLACE MSFF fI S - HOODSmm{r4) ' ' ,
BOIb4RS : FURNACES. ' HOT WATER TANKS(Gan) '
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 Smkn) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Knchen/Unbty) WATER HEATERS(Blertnr)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
N IA- ►..)1A N//k $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
� � • � N I FiYes ❑ No ❑Yes +'No
VI( A 1fLM T- 1
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
teiy"»:_. - '"` ,i:"1, - +c3.. •vt i•,•-r-''�`" vli �:krc, r.'�-tts r�,r:-#�'•=t-•Se,
FIRST FLOOR(or Mobile Home) cue
fie/17FtM 7.1:.it; .11 '','4'-',,,i','3''-�,..7.11:t.3¢ jM:r.; ,,• a: .,' 3'3,,IQ": 14'','"4�rr tin`'-�,A'i=1.9'',`x';.'v'`yam/": 5,•. ,, ---,__,,,,,,,, •
i R4" 'i,�ri+$ 4,Kiy'",;,e t 3t- l
.'t'L�''tFk:,, - "T,'a ;., '.ti1;3 ;E.�+✓.,� ` va";;moi Tia•°„ica,� qi - ;.'_• '.'-'1----••••••••
........................ ..... - --
COVERED ENTRY
y ': � s =" .�`•fi/� : .k.,y.K.'+• �.�4; Sn: ;# x6 +.•: i. ,i,,,#yt >A.'i �'';:,:, :s, u:
GARAGE ❑ CARPORT 0
A' .)J• ,t .It • .^ ,-: , ':r'" H'>, "� I: "k
V (.� ,+Sr ,'_x
s+, _'�- , 'r1 €t W ...r " :,�x. ;. . i,,
.'.,,,, ',4. 7"K',` 4+ `-. ^1- ._ 4.'-_-` '`• `z'.
Area Totals �"'"0 �`O TOTAL
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square FeetTlype Stories
'tY,-� ,4t:j-,'-t,- .. •+moi-,-` I .. l'..,...,'
- , - . .'.'' .-*:;`:'",•S- A.=-•i'ri�LL:v`^`-- -,`:. ,-.--,,;2,...,7,,,--,-- •"4 +.c.:,Y• _
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
in Square Feet TY”! Stories
TOTAL. 40 , ' ;
TENANT AREA ONLY %414 S
I,f tr' ",' .
Bulletin#100—January 1,2013 Page 2 of 3 k:\Handouts\Permit Application