17-104059 ,„„,A. RECEIVED PERMIT APPLICATION
CITY OF AUG�±
2 2 2017 PERMIT CENTER+33325 8th Avenue South +Federal Way,WA 98003-6325
Federal Way
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
CITY OF FEDERAL WAY
COMMUNITY DEVELOPMENT
PERMIT NUMBER / _ / 0 7 p 5 �j' _ C 0 7 (9 //I-
-TARGET DATE
SITE ADDRESS SUITE/UNIT#
115 e 4,. '7't \\
PROJECT VALUATION .ft—c'
ASSESSOR'S TAX/PARCEL / 0 Y _ ^
TYPE OF PERMIT jlet BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT ""i"ia. pE J==. J 4 -1?-44144-\ c.-0*.t4crr
PROJECT DESCRIPTION yp� er 1 ' -re -}�X - ' b ¶rf��i 14
Detailed description of work to W h p 4-1-6/2- ,NTH(_ dCTTS
be included on this permit only (� "'ti."(�1
-- - NAME...___7_,......A. +' -- -Caeii.../ ---_ — PRIMARY PHONE - --
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY '/ STATE ZIP y1 ,,y,�
--- --- - - NAME, HQ4 RE / C T?T4415 t P N lvia•lit
MAILING ADDRESS 4 1 q
CONTRACTOR r• 0 • r�S' 11/1,454=:$ p- In 6 V�J�t tcAr* cc
CITY STATE c - - S�J ZIP lap 6.1., FAE
WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
...Jf yl-t 105trep it./-op i4e)
NAMEPRIMARY PHONE
S .a3 "r. e (i N 4`i( ` l c-4
MAILING ADDRESS {�+ E-MAIL
APPLICANT i ' cp . 6�,� S 5 a 11 b�,�.445 n 0:arrN
CI STATE ZIP FAX
N iloek wx'
NA WA 1802/
�(�'' PRIMARY PHONE
PROJECT CONTACT F✓* ?ir ! (S AMSC
(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 19.27095)
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
ail 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.
_ � DATE 8/4-/- /I
SIGNATURE:
PRINT NAME: t' C off/ 1
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(Commercaah _
BOILERS FURNACES HOT WATER TANKS(Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
I V''LIE.n,.aril—I
,,. .. G WV._ I
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/Utility) WATER HEATERS(Electna
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
3
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURV[YOR' 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
•
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- FIRST FLOOR(or Mobile Home)
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COVERED ENTRY '
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GARAGE 0 CARPORT 0 ,
Area Totals [ EXISTING PROPOSED TOTAL
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ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
yr Area
Construction
onstruction #of DESCRIPTIONSquare Feet ,Occupancy Group(s)
Additional Informa
tionSoT{�e tries
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ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION S.care Feet Occupancy Group(s) a Stories Additional Information
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TENANT AREA ONLY
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Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application