10-102185 42 - i 0 61,_ ± 1 _cs
""°'�� ERMIT SF MF CO ME PL DE E FP
Federal W' ►E CEI E�
COMMUNITY DEVELOPMENT SERVICES P LI CAT I O N
253-835-2607•FAX 253-835-2609
www.cityoffederalway.com MAY 2 5 2010
SITE ADDRESS C;1 i Y OF FEDERAL WAY SUITE/UNIT#
20 kO S cES4 41-" ST..a€T A-2 A-2
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 2, 124 ,00 .2 6 3 3 0 - 0 0 0 O
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ENGINEERING > FIRE PREVENTION
NAME OF PROJECT ` � �
(Tenant Name/Homeowner Last Name) G-402A1/4:-.01.... v O W A}
PROJECT DESCRIPTION C
Detailed description of work to A OD SPR IN\4 L C S BE Low MEW i-A a zZ A . 1 ..1 a
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS E-MAIL
CITY STATE ZIP
NAME rtglE SQRtI3KLt 1AC, PHONE ) 9z6
CONTRACTOR
MAILING AD5 4E 1 4 J ►RE l E. it 02 E-MAIL
CITY STATEZIP FAX
30MiJEr2 'W A 5B2 (.255)826-i033
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAT BUSINESS LICENSE#
FlAES 1')`5 1iZ / i 1 vO 2O--OS-topL
b33-00B
NAME (i& 5-rJ/p\zr OP F S - PHONE
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT NAME PHONE
(The individual to receive and
respond to all correspondence II NG ADDRESS E-MAIL
concerning this application)
CITY STATE ZIP FAX
auras=CONTACT NAME: PHONE E-MAIL
PROJECT FINANCING NAME o OWNER-FINANCED
Required value of$5,000 or more
(RCW 19.27.095) MAILING ADDRESS,CITY,STATE,ZIP PHONE
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 ' -'rt o th application.
I
SIGNATURE: ny DATE 5/Z 1 /13
PRINT NAME: ...•*" i ir
%M S T aW • 12-T
Bulletin#100-April 14,2010 Page 1 of 3 k:\Handouts\Permit Application
. • •
A MECHANICAL FIXTURES
VALUE OF MECHANICAL WORK $ (a copy of bid or estimate must be provided)
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 OUTLL15 OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(Commercial)
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLUMBING FIXTURES
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 Smks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/umuy) WATER HEATERS(Electric)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
COA -KAKe 1-4Av 014--LA4EikA4ai $
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 0 CARPORT 0
OTHER(describe)
EXISTING PROPOSED rorAl.
Area Totals
`*NEW HOMES ONLY"
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction i«of Additional Information
in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction of Additional Information
in Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY 37C12(' 1
Bulletin#100-April 14,2010 Page 2 of 3 k:\Handouts\Permit Application