17-103410 M�
JUL 7RECEIVED 2017 PERMIT APPLICATION
CITY OF 111111
Federal WayPERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
CITY OF FEDERAL WAY 253-835-2607+FAX 253-835-2609+permitcenter(%cityoffederaIway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER I 1 _ I 0 3 LI I 0 _ v
TARGET DATE
SITE ADDRESS SUITE/UNIT S
►� �zS 3Zyt�. 5-k 811 s
PROJECT �TJ�N ZONING ASSESSOR'S TAX/PARCEL♦
5vV � � � -
1 5 0 0
TYPE OF PERMIT $UILDING ❑ PLUMBING ❑ MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
O t
R
PROJECT DESCRIPTION IN%et.541L.. 4 6 L f tJ' a re....— 1.,1-t t s "Pb r i1z' "v►/`C.. .
Detailed description of work to "1:e......dit. 11'4,-. ro v r�.;� .
be included on this permit only `
NAME ,�.1L ...�L _,1^ .�., PRIMARY PHONE a�
PROPERTY OWNER 1 1 a.e S�� �'o p�.-1- e.S " f1�a1t.* 2.53 12.2...• 11��
rail,
1
j003 a..a.:�.• U.., �"':�c Z Iia 1•r• �.Lars�st"wr
STA E y C1
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`,eirbW,.r►-••� '��4`C- Cbz-1..-. z1'tni, /$2S l�''} $S Q
MAIL
CONTRACTOR )' I 1�e�...�1•1' �/e$%.t)vw..4.f.t..GC,01Ar•CP.4
541.strs 1 ND�� TE
d• I S bl� FAX
% LICENSE I!
POL.? .E.E �°�2Li 6,4,47 ItEXPIRATION(V / 1 e6 1°1.1 KYLS 18 40 .
NAAS (/`� .} y, PRIMARY PHONE
APPLICANT MAI G ADDRESS EMAIL
CITY STATE ZIP TF�AX
HONE
PROJECT CONTACT NL L C 5 P4 4135 q 1
(The individual to receive and �` EMAH'respond to all correspondence3r ,D.,n e y _concerning this application) STATE ZIP FAX
NAME
PROJECT FINANCING N k S 4LTr o PPS"t`�v' OWNER-FINANCED
When value is$5,000 7.095 Or more IO Gbh N}aiQ`CITP,pT'�,Z.1 w A `_ z- 2.S 3 /2 PHONE11 b
(RCW 79.22095) �''11[,J 10�` C `f T
I certify under penalty of perjury that I am the property owner or a orized 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.
SIGNATURE: `/
DATE 1 1 ' 11
PRINT NAME: .0" v-41.0
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
. lir
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ C�
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(G.,1
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBINORK
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 dor Tub/Shower Combo) LAVS(Hand Sink,( TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(I tehen/Unhty( WATER HEATERS(pe,tne)
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
131 •
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
C3lfc{ 1 ;.
Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction *of Additional Information
Square Feet Type Stories
•
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction Sof Additional Information
Square Feet Type Stories
•' •
TENANT AREA ONLY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application