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19-104905 A., RECE��r LLQ PERMIT APPLICATION CITY OF Federal Way OCT 10 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325 253-835-2607+FAX 253-835-2609 +permitcenter0,cityoffederalway.com f CITY OF FEDERAL WAY COMMUNITY DEVELOPMENT t PERMIT NUMBER C l Q i I e TARGET DATE OA 1 / 19 SITE ADDRESS SUITE/UNIT# 32175- 32‘,..1- Ave 5. r ..,,L W , WA 9ea,3 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# $ 3c coo, cc 0p - 1 Z 1 S 9 b 5 - 0 1 1 0 TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING XFIRE PREVENTION NAME OF PROJECT Da,V'ts.� G,&7 �x 4,br1 PROJECT DESCRIPTION j ,, / Detailed description of work to U1'i40- bet-%•••‘,C PrL P j t1' Ski...JL. be included on this permit only n f":"3-1- I w ' irlat. t t.....014t.....014i'oh -Y, A ios'� =AAicc�� Vo -6 rises r1 � ���"� t A i rR. - NAME11 PRIMARY PHONE . Oev S;s K(- OCV T LJ-C. PROPERTY OWNER MAILING ADDRESS 11 E-MAIL zOz? 16.1 5-1- CITY +CITY STATE ZIP allIAL.0- GLC $O 202 NAME PHONE M A ,&isi Go#H 1.i ZS- 3Z8 - 1:00411 MAILING ADDRESS E-MAIL {� CONTRACTOR 1 c7 23 0 AI E Poi1445 D R Kls. P,...16 e.v►Q A0,4046,3..cslM CITY STATE ZIP FAX KieIdc. �✓A 9$03 WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE# / / 2.0 -19- IO399cn-OO -A- NAME PRIMARY PHONE P. A ?45-. ,z,5v‘ fir,• Kle.. }Po.+(S2-v 9 z5 - 32-E - 6049 APPLICANT MAILING ADDRESS I E-MAIL 10230 NE Pons Di . lt. Paul-se-4Q i''►.or-evisoy►.ati CITY STATE ZIP Ki�'hi4NJl. wA '\ c'33 ®-. - NAME ^ y PRIMARY PHONEK le PROJECT CONTACT kD .S<.vl u R5" 3 z 8- 601+er (The individual to receive and MAILING DRESS r E-MAIL respond to all correspondence 0230 1W /o,�-1 OR K te..Pc...aseY1 eikoeleosim.com concerning this application) CITY STATE ZIP Flet Kw \AA 18 033 NAMEwn be. u L- rkie..,- OWNER-FINANCED PROJECT FINANCING C/ 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 suppliedieedtoothe city as a part of this application. SIGNATURE: �J L'^. � DATE IC) 1001 PRINT NAME: Er 1 n uon ile-( 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(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 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(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 BASEMENT FIRST FLOOR(or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER(describe) EXISTING PROPOSED TOTAL Area Totals *NEW HOMES ONLY"' ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERCIAL-NEW/ADDITION AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information Square Feet Type Stories NEW BUILDING I b01 otX7 �u pe it - 6' 0 EW 3 ADDITION `J\` COMMERCIAL-REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area m Occupancy Group(s) Additional#of Additional Information Square Feet Type Stories TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application