17-105578 ., VE-
E
CITY OF �-- Nov 17 d11 PERMIT APPLICATION
Federal WayCIN Of- FtL EflAL WAY PERMIT CENTER+33325 80,Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609+permitcenter(ucityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER 7 _ Cj /
/ g - TARGET DATE /A - IS l 7-
SITE ADDRESS SUITE/UNIT k
3 15 W 1 0-0 ft v'o C-Cni-tr BIof .
PROJECT VALUATION ASSESSOR'S PARCEL
$1001000- 00 0 , / 0 cli - 7 / 3 L
TYPE OF PERMIT ❑ BUILDING PLUMBING ❑ MECHANICAAL El DEMOLITION ❑ ENGINEERING 0 FIRE PREVENTION
T�
NAME OF PROJECT /7 (-are kal L/ S /e'114
PROJECT DE '"` V V •X rt S �d YU n
DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER M t'�'I ii Caere eat tin S 1St ms
MAILING ADDRESS E-MAIL
315 wt oui n (,u, e r VI nod VOI
101Lornot STAR
ZIP6154i 5
NAME PHONE
44trma.nSon Com b- 2.Oct-cis I1-9o9q
MAILING ADDRESS Ave, 1�E--MAIL
CONTRACTOR 12L1 2na ti. Taylor. Meats'le hu►M6vv0*,.
CITY STATE ZIP F C•'1'1
an+ 161 Il ct ro 3 2
WA STATE CONTRACTOR'S LICENSE i EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
14Eg.MAGt, Bey $ ,- 10 /LT /t4'
AWE PRIMARY PHONE
1°41or 1 UvVe-rkir 112..0 1.0-cK Ii -41 04141
E-MAIL
APPLICANT 12-1.1 DRESS
NAILINGADZ nd �/t N tailor. lowe 1-8 h(rman SO W-
CITY 1� •A- WA ZIP
1 V'NOR Z F wm
NAMEC�t'n� CM)
n 1 L PRIMARY PHONE
PROJECT CONTACT ' a AS CM) p 1 I COW+
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME ..PROJECT FINANCING •Etr YYl Qt-/')S ('l C O m( n 0 OWNER-FINANCED
When value is$5,000 or more G ADDRESS,CITY,STATE,ZIP PHONE
(RCW1927095) Itti 7 rica ft.
vL \1. ani")
WA
a /]t037
I certify under penalty of perjury that I am the property owner 7o`rlauthooizrizeldT agent ofthethe'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 suppli to the city as a part of this application.
SIGNATURE: I 41 DATE 1 I /1 1 I 1
PRINT NAME: f A I ♦ h/,
I
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
I•
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 art of this project.Do not include existing fixtures to remain.
BATHTUBS(or Tub/Shower comm( LAVS(Hand Sulks) 4 TOILETS WATER PIPING
T DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
1 DRAINS SHOWERS ii VACUUM BREAKERS
DRINKING FOUNTAINS 19 SINKS(Kitchen/Ubhty( 1 WATER HEATERS(Eloctnc(
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)
Area Totals MATING PROPOSTD TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area In Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
lbw flusunro
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction of Additional Information
Square Feet Type Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJZC!AREA ONLY
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application