19-104904 RECEIVED
lir
►� PERMIT APPLICATION
CITY OF OCT 2019
OCT O PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
Federal Way
253-835-2607+FAX 253-835-2609+permitcenterOcityoffederalway.com
CITY OF FEDERAL WAY
COMMU5 c rNIITY DEVELOPMrENT(
PERMIT NUMBER _ v �/ "' _ F �I /�
_ _ TARGET DATE /// '
SITE ADDRESS SUITE/UNIT#
ligl 2.0o 9.aqd Avti' 6 . regluto e Wil►A3, wA 9/0°3
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
$ 12, 5i(6 . o o— O 9 2 1 0 li - I I 7. 7
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 91..FIRE PREVENTION
NAME OF PROJECT 54,i (,fie 4
Add exiwo Ottocv.k. 6PrAkter h.e.ds .Cor new wall
PROJECT DESCRIPTION ` �
Detailed description of work to 4,9
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
4194'A f� Po box g212q
STATE
CITY L 6 C'ke ZIP• T6 o el 2-
NAME V�eskr n S I•a.�es F; Pro kc F�'Gtrl PHONE uc- 3,01-0100
CONTRACTOR MAILING ADDRESS l.,6 q0 /OE Q c ‘+-fe4i (.0%;e-Ioi EMAIL
CITY STATEZIP FAX
1e•C640nd wgee)57-- f- 8YI-Joao
WA STATE CONTRACTOR'S LICENSE 41 EXPIRATION DATE FEDE WAY BUSINESS LICENSE#
(!►les !-es F f 3 6 sS- 0) / 19 / 2 l I 'fig -fw6 N16-oa-3i;NAME PRIMARY PHONE
imv.e.50r• 6- ae 206 - 5o3-3171-1
APPLICANT MAILING ADDRESS E-MAIL
l t{&qo N!= gs-14- 5ivt.4.4'• GIM:). jot Jarsesah. 61:‘,00lc6 wsFP.tis
CITY STATE ZIP FAX
ge-C6(M.A W4 elite, s''- 4 Zs--5i - 3403 co
NAME /' PRIMARY PHONE
PROJECT CONTACT .JOWVKSGr V0-04L-� 2.6E - so 3 -3)*Pf
(The individual to receive and MAILING ADDRESS L---'_ E-MAIL
respond to all correspondence y6R0 Alf Rc -T unI to 1 .3~1(04G419w8FP,us
concerning this application) CITY.... STATE ZIP w FAX
Kir uq�,� r2_fT1.17s-13*1- 363o
NAME
• PROJECT FINANCING El 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 - es out of the relianc of the city, including its officers and employees, upon the accuracy of the
information supplied to ci as a part of this �'ion.
SIGNATURE: y DATE 1° i i a C�
f/` F
PRINT NAME: JAM P see V VA/A"C--
Bulletin#100-January 29,2016 Page 1 of 2 k:\I-Iandouts\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 mb/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
c' 1- $
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
Yes No 111,Yes pc No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT i'
FIRST FLOOR(or Mobile Home)
Atha*
u \
COVERED ENTRY
GARAGE ❑ CARPORT 0
Area Totals EXISTING PROPOSED TOTAL
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL-NEW/ADDITION
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet a Stories
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
TENANT AREA ONLY
�,. �\\� • .ma `
w max- / .•. ....
Bulletin#100-January 29,2016 Page 2 of 2 k:\Handouts\Permit Application