17-100311 CITYOF .�...•
JAN ,11PERMIT APPLICATION
�, . l PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal ay ftp. .(r' OF F�. 253-835-2607+FAX 253-835-2609+permitcenteritcitvoffederalwav.com
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PERMIT NUMBER 1 1 0 3 1 I - r 1 I 1 7
TARGET DATE,
SITE ADDRESS SUITE/UNIT a
425 SW 323rd SI- 1 FedJTa( WA 01Kz3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 0
$ MOO-DO e -1 3 2 0 2 - ® 6' + a
TYPE OF PERMIT ❑BUILDING 154 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTIONPefi 1 a(� ei I S ,6X 1 y2.S w r4'h link) i 1 bac-iti 1 U yn.
Detailed description of work to I1�'ZI I 1 11W) Y h ova and , -.,rhirei A r kr1C/VVI
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER \I C
�2� s V `J23'� - - LMAH lv JR
CITY----
'TY\-e0,lel \NP\•/ r` n 7g ZIPMO23 !$Q
NAME Plurnbio6f inIJ Lu �l 0-2z-Wl-/i
CONTRACTOR 50"1 ` oth p). mAl%Vs COBE 5M {
CITY Kzak_
SIM utig0.32- FAX WM,
WA STATE CONTRACTOR'S LICENSE a EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE Y
NMAIIN.ADD p�Um109 s0)��i s LUI PHONE /1
APPLICANT 25201 skttn 0. 5• Ee coli%hie J
CITY l o l l ST ZI O Z FAX A
PRONE
PROJECT CONTACT Ot NAME (K.(. Gea v I 200-22o-I(J iii
(The individual to receive and KAMIIG AD'` th `n E-
respond to all correspondence •�1 3i,,� p S. if J/ lj l.li � /��"
concerning this application) CITY O.t,� , rig znh/yi � FAX ,,`o
PROJECT FINANCING NAME q�I I;\ol
0 OWNER-FINANCED
When vniva is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PRONE
(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 im arises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied city as a part of this application.
SIGNATURE: I DATE //ii/i7
PRINT NAME: &I l') (b v'/-
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
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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.
T>—_ BATHTUBS(or Tub/shover Combo( I LAVS(Hand Sinks) TOILETb WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS Kitchen/Utility) WATER HEATERS(Electric(
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
FIRST FLOOR(or Mobile Home)
15014444* s: f _p•' __
COVERED ENTRY
GARAGE 0 CARPORT 0
•
C111l
Area Totals COATING ?Roroeso TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION
Area Occupancy Groups) Construction #of Additional Information
Square Feet Type Stories
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Occupancy Groupie) Additional Information
,ape
oars Feet Stories
TENANT AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application