17-100202 VIVED
CITY OF ��-- a�, PERMI' APPLICATION
JAN 1 2
Federal Way PERMIT CENTER+ 33325 8th Avenue South + Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
MY OF FEDERAL Y
�J .7q
r,
PERMIT NUMBER 1 l _ �/ b _ `� TARGET DATE / / /2117
SITE ADDRESS SUITE/UNIT#
7 7 S- a . 3 c ` s-1--r-e.c2.4- - cearcret( t,.1 A`(
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 4s-0 7— et2._ 1 oy9a / 0
TYPE OF PERMIT 0 BUILDING 0 PLUMBING yK1VIECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION ___I-n-r 4 ( A `a,`5 e- o`,l % n ` i jvla.n
Detailed description of work to K t h-h e/ 0 T #(,...0_, CD NWS ee.4 D^
be included on this permit only _l L L J,, r-4- l,./ A. L/l
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRES E-MAIL
S I'S Zc- g+t.A--t,,e,l.,te_ S-E4,44-1
CITYSTAT ZIP
Ft-� c�{ca( W W 41P003
NAME PHONE
0 LA)ok.Cr.
MAILING ADDRESS E-MAIL
CONTRACTOR
CITY STATE ZIP FAX
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
/ /
----Y- NAF. - -- --- - PRIMARY PHONE - - - -
J L M (Borr btr. -Pa.tics S crassr- ZS3-Z4/-/7I
S'
APPLICANT, MAILING ADDRESS E-MAIL
333 z r 8-- Pie _ So..-44.. ,\ams, cv� �►4�
r.-4�ti` STATEAl80
ZIP, -07 FAX /1 ��
WPC t/-til Wim,„e9P.
PRIMARY PHONE
PROJECT CONTACT 6(ryQf -Pari.f st,r eru i aD - ZS.3 -z-C/-/7 7r-
(The individual to receive and MAILING ADDRESS ..... E-MAIL
respond to all correspondence 3 33 ZC O f'�eiuA`go" ^ _la MQS.r AP-6C/.M3G illy O�
concerning this application) STATE Zie FAX c.icr-1,4A7 .c),tA
NAME, 1
PROJECT FINANCING / A.ti 0 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 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 ` -` 3 ` 1
/ // --
PRINT NAME: L "J /1-. Ci!'`t-r-
Bulletin#100-January 29,2016 Page 1 of 2 k:\Handouts\Permit Application
• 0
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offrxtyre 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(Commercfiat)
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 fvcture to be installed or relocated as part of this project.Do not include existing fixtures to remain.
BATHTUBS(orTob/Slower Combo) LAVS(Hand Sinks) TOILETS 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
x Ail br.t :'s ; a,". :r,.. ,.a+.4I^`f' ;'t e.:t'.t t ;r.;�•''P-'4rF,` n.,4"'., t. 7T-,T .4.•''y _____—..._......._..._.______....__._.._......_...__..._._��..
Ift
FIRST FLOOR(or Mobile Home)
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t,i.,,
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COVERED ENTRY
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+
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GARAGE 0 CARPORT 0i.
s'.s:-a T; ',i:.f:' ,ui „r-4,7,,,i 1.1:4-a'+,t •s h .c+ ; *..:'/ "... _..-
04r '5,rz,,e. H"ia�,1 ,',4,, '<i':;�".py4#` 1 �sn "t-6y"��jj t., ;{,:; n ,. {i, 4 �,
., ,...%,..-:,-*. !." u*.. r;..s;v ,:k','i•xitYl •
. F..i,;44,.`;',..,,,,-,,,,,,--,;4 :. `.?�5:a.•. ..._ ?•-o Mi:r:':-1/�3i ';t�';"'„x'r............_....-....._.�_..._.__..._._-_._.—____-Area Totals EXISTING PROPOSED TOTAL
'',377447.77,77,7277.7.'c .";` r: ,,o.T ads? . ,tn;;"�' ar
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
S.uare Feet 'pe Stories
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^;L, ., F," .7.� 'Ibr `,{.♦, .},”. .:1�{r�%' .v>`�" u .:h..'1`�`.'f" a{ 72�,. , t .y .Y,•i ��3i ♦ IT,x t
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area is Occupancy Group(s) Construction #of Additional Information
S.uare Feet ' .e Stories
'7..
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i:: � .z'- ,.76 ft`s '#''!C.:'"(',s ':..<,t4;
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TENANT AREA ONLY
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application