19-105465 ,„,„,,,, „A, DECEIVED PERMIT APPLICATION
CITY OF
Federal Way
NOV 13 2019 PERMIT CENTER+33325 8th Avenue South+Federal Way,WA 98003-6325
253-835-2607 + FAX 253-835-2609 +permitcentel@cityoffederalway.com
a I Y OF FEDERAL WAY
C(V4MUNITY DEV OPMENT
PERMIT NUMBER `� - G d yJ _ } ,c...)
TARGET DATE / 1
i77---26,
SITE ADDRESS SUITE/UNIT#
IS20 3Ci.6ii- S'
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL# _
$ 12, 7pr1UJ 3 `/ 1 Q 0 - Oj L 5
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING V1''IRE PREVENTION
NAME OF PROJECT (G C 5 J� `�, ,S
TN ,�.� 1J RI-Q. f)l�rn" S C aa, cie iCr.
PROJECT DESCRIPTION K y S
Detailed description of work to
be included on this permit only
TEk PRIMARY PHONE
tk 3(� P85 - v-1-tv 606/
PROPERTY OWNER MAILING ADDRESSE-MAIL
34 C.-()c) �M01 erreCI—
N1 ss PHONE
-VI-V�)5lt P 'ner5\-►.? 5)7-- 7I S IS 77
rijAILI1f 134c -'1 \
NG S
CONTRACTOR e VV �� v -Rett Ic V/�4f f))
ST E ZIP FAX I (Jnn
\Z rove 9) I(G
WA STATE CONTRACTOENSE# EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE#
CCft55e-i- �36J 12_ It 19 7o-/ ) 1oa- (-ao -aL
.. .. NAME PRIMARY PHONE
2& I
APPLICANT MAILING ADDRESS E-MAIL
CITY ill STATE ZIP FAX
El e. PRIMARY PHONE
PROJECT CONTACT c� V/-J1�,j
(The individual to receive and 7,ING
��ADD / E-MAIL
respond to all correspondence V .
concerning this application) CIT -' STA P FAX
NAME
PROJECT FINANCING ❑ 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 arises out of the relian of the city, including its officers and employees, upon the accuracy of the
information supplied to ii city asAlfof this ap•ii cation. 2.c.)15"
J �j
SIGNATURE:
/If,
III, //i • DATE 3/ LSJ1 /
PRINT NAME: V ` A,i, i
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
BAS w �� tea: ,;.
FIRST FLOOR(or Mobile Home)
COVERED ENTRY
` , pr :r �,t+3„+wtax rff �!%fnr9 .r, _............................._.... ............_...__..._..-........_.......___......._._.__.—..__.—..._.
y"
GARAGE 0 CARPORT 0
EXISTING PROPOSED TOTAL
Area Totals j�r�j�J ■/may �n
ESTIMATED SELLING PRICE$ #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
AREA DESCRIPTION
Area in Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
z -/�., > �1�/ 'r G` C$ ' n �f ,
•
a 1
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
S.uare Feet Type Stories
LDING • •
T ,, s s F,r, = tif. a .,
TENANT AREA ONLY
xt " ; ,I %i 't'i` � y, �7 • ., x r,
PROJECT AREA ONLY K his
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application