18-102274 IMFRECEIVED
CITY OF . MAY 25 2018 PERMIT APPLICATION
Federal VVay CITY OF FEDERAL WAY PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
COMMUNITY DEVELOPMENT 253-835-2607+FAX 253-835-2609+permitcenter(ricityoffederalway.com
PERMIT NUMBER I 4i3 _ I 0 2. 2 1 _ S F N/ A
TARGET DATE
SITE ADDRESS SUITE/UNIT#
143 Sw 3 \c
C‘)W4 D\ �edeV \Al&k q 02-
PROJECT VALUATION ZONING ASSESS() 'S TAX/PARCEL i
$ 31 i 000. OO ,� L j_ O- - 0_ -- lD n
TYPE OF PERMIT BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT Pe. ys o 9,e,Y O U-E
PROJECT DESCRIPTION e'Y vv \1e- .e_X 1 Sfi1 Yl f I S% ok,V� Y 00-1-111v) I t 11 I
Detailed description of work to V/\-eI A V 2�� 1 L G(_h lCl �e t4' CO V posy leC bio r9
be included on this permit only Y
NAME'ReArie,e, YWIMARYONE
`�(Q 2 516 '2q 71
PROPERTY OWNER MAILING ADDMS
►-1.3 I S. I _ `
`51 ` 5+CITY E-MAIL
ZIP
S-ea -c,e, �`vo clct 02 3
PHNE
NSU�l e�n�n np, `(�o�1nC) 2riie• 5. 7g Y7
1711 ADDRES1 ,,,_ E-MAIL
CONTRACTOR \ r `V V`��{"1 �J
�) , 1 Y , 1U l S&hedail YI j7 Q VGA a
CITY�u�w1 r'^�I `/ STATE ZR l 0 in FAX
Com
42e 1 - -V CONTRACTOR'S LICENSE
�VC /192bIO565Md5L-
NAME PRIMARY PHONE
S111\4E cc coNrr g C
APPLICANT MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
NAME �y� PRIMARY PHONE
PROJECT CONTACT S e 0 S Co/U' � U) .__
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING OWNER-FINANCED
When value is$5,000 or more MAILING ADDRESS,CITY,STATE,ZIP PHONE
(RCW 19.27.095)
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 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 def- of such claim),which may be made by any person,including the undersigned,and filed against the city,
but only where - claim • ses out of the reliance of the city, including its officers and employees, upon the accuracy of the
information su •lie• to he ci \as a part of this application.
Ir__
SIGNATU'+1r,I�OW DATE 0512a 19.0 t tb
PRINT NAM':_ ,<J A . :t(' citij.Lc&vcj.o ,
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 FANS GAS PIPE OUTLETS OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercul)
BOILERS FURNACES HOT WATER TANKS)Gaol
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.
BATHTUBS(or rub/shower combo) LAVS(Hand Sinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER(Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS(IGtchen/Utthty) 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 0 No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
GARAGE ❑ CARPORT ❑
yQiii R(dee b _
Area Totals y� j. �EEXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area Occupancy Group(s) Construction t«of Additional Information
St�uare FeetType 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