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-
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irlat. t t.....014t.....014i'oh -Y, A ios'� =AAicc�� Vo -6 rises
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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