17-105579 1
... PERMIT APPLICATION
�
CITY OF
Federal Way PERMIT CENTL 1 South+Federal Way,WA 98003-6325
253-835-2607+ 5y�l�g}.�permitcenter(•cityoffederalway.com
i NOV 17 2017
PERMIT NUMBER 1 .- _ 1 O 5 S 7-C _ M CITYQ� �]�q�,�y/,Y 1 /15 1 -7-
- — -
COMMUr.eirr '�C7FMEM'
SITE ADDRESS SUITE/UNIT M
3I'6 Le 1 .touttwo,,t4 cwew E1 vat 3 .
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL S
_ bOi000 09Zc04 - 9137-
TYPE OF PERMIT 0 BUILDING j'LUMBING MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT k VIII CAI 1.-V4--TH Srll't
'
NI fvV auGl-ino. -ft.r 4 1-TA'S . Gtn'1'Vs < -e to
PROJECT cDESCRIPTION onwork
to - (-011 n }-d d (1..) 2 ILA()(u sq. �ax�.
Detailed description tLon ofwork
be included on this permit only
NAME
PROPERTY OWNER t i-i Caere're. en l S VI-CMS
PRIMARY PHONE315 G Y`Lou i-i n LU,4-N-V Vi nod rt'1 E-MAIL
1 ALOYna 1AI zll'�1�4�5 a
NAME PHONE
44{rman SAn Com pa-rut Zat..-ceii-9 a9q
MAILING ADDRESS E-MAIL
CONTRACTOR 1Z.L1 2na Ave, N. ZIP4-a4-10r. tbwcr ita!fie/1111124o*..
CITY STATE ALP NW
4'441 W A °1 t-o 3 2 F
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE II
1.1 M#CG00€ $ - 10 / Li' /1cie
PRIMARY PHONE
10✓ t no/'-t(4,- LL Lv-cK 11 -ci oge1
APPLICANT �] ` no( ,ADDRESS E-MAIL CITY STATE ZIP FAX /,�
`1.1 7 n \+�t N tIOr.• IOW 8 h 5014
VC.nA- WA `l 03 2
NAMEC� tt PRIMARY PHONE
JCL
PROJECT CONTACT I l e AS C4J p 1 I CQ(,n+
(The individual to receive and NAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME /�
PROJECT FINANCING '�Q Y YY1Q�•1'�S o n Corn pp-Y1 0 OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW19.27.095) IZZ1 7 n,01 # of IV. le.ewLi-) WA n`OS�
1
I certify under penalty of perjury that I am the property owner or authorised T agent oCf-Ithe-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 kermit 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 d to the city as a part of this application.
kl
SIGNATURE: I DATE 1 1 /1 I I 1
r 411
PRINT NAME: r . 8 ♦ V
I
Bulletin#100—January 29,2016 Page 1 of 2 k:\Handouts\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 I FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commerc.al(
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING(RT us 5) 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 sinks( TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(Kitchen/Utdlty( WATER HEATERS(Ekctnc(
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 0 CARPORT ❑
OTHER(descries
.......
EXISTING PROPOSED TOTAL
Area Totals
"DEW HOMES ONLY**
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square FeetType Stories
Ilsw Byname
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area m Occupancy Group(s) Construction of Additional Information
Square Feet Type Stories
TOTAL Bitli.Als4
TENANT AREA ONLY
PROJECT AREA OILY
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application