19-102672 'RECEIVED
. PERMIT APPLICATION
•CITY OF JUN 0 x,! 2019
OF FEDEr3AL,
Federal Way CITY
COMMUNITY DEyELOP"i
AIE,PERMIT CENTER+33325 8thAvenue South+ Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
N7-
PERMIT NUMBER / q _ / 40 ( / _ � p
r ( TARGET DATE
SITE ADDRESS S SUITE/UNIT#
1PRO70
VALUATION��/ Oi +Z ZONING !`{� ��SSESSOR'S TAXC PARCEL I 4/ c 0 O
$ / $ Q4 / oct - 034/
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING/@ FIRE PREVENTION
NAME OF PROJECT —
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p,it E 7-7 iy- /14,/J., 5-7 IAC-i--%--
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
_ NAME -- .�.- _ PRIMARY PHONE
PROPERTY OWNER MAILING ADDRESS E-MAIL
CITY STATE ZIP
P
NAME ! PHONE
/ ,'/`i!/ Wl"tc/ <-77,(C-
MAILING ADDRESS' e E-MAIL
CONTRACTOR /9 z& A) /tier� - Si
/ 3,5
CITY STATE ZIP FAX
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WA STATE CONTRACTOR'S LICENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
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NAME/ PRIMARY PHONE
r Mr" ....•e— rn� Svc' ll6B 3 z_y
APPLICANT, MAILING ADDRESS E-MAIL , s-44 ,p ✓
i .V i(lca..,.�.,FST (3, s��el� .off�c� LtC
ie 210 ! ,...0.o!)
CITY STATE ZIP FAX
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NAME , PRIMARY PHONE
0
PROJECT CONTACT !l Srlilr11.6I0J z o4 5-If -/ 25
(The individual to receive and MAILING ADDRESS / E-MAIL
respond to all correspondence )0 Z Z& /1) I'tJ ✓.0A S1 It(Y., (,t75°it(pE+^ii,tertf7[JE?/r(tJG.O1tG+
concerning this application) CITY STATE ZIP FAX
bid" 9f71 3
NAME
PROJECT FINANCING 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 arty 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. ‘A,/,4+/�4
SIGNATURE: '`1� DATE �9/7
PRINT NAME: tel/.ill 'J yLte"c.< ---
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(cas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT $
Indicate how many of each type offixture 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
BA EME1�T .'
FIRST FLOOR(or Mobile Home)
O� ,
t '
COVERED ENTRY
Wit' r
GARAGE ❑ CARPORT ❑
n.��.. +fid✓ " "; " � _....._..__ ._..._.___-___.-____.__._....__..____..__....__.—.__....__.._.__........._..
"• EXISTING PROPOSED` TOTAL
Area Totals
ESTIMATED SELLING PRICE$ # OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
DING:.-.,; s,,.,, 9 A; ��t "
A`., /�,/- ' • -.
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
Area in Construction #of
AREA DESCRIPTION Square Feet Occupancy Group(s) Type Stories Additional Information
'Agez .. . ..
Ui TIN fr414f �� rr
''�^..,q,r .�. 4
TENANT AREA ONLY
PROJECTAREA Q � r j j
'��,���
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application