17-104993 ( ort cB .L.
_..4.... PERMIT APPLICATION
CITY OF
Federal Way PERMIT CENTER+33325 8d*Avenue South+Federal Way,WA 98003-6325
253-835-2607+FAX 253-835-2609 +permitcenten@cityoffederalway.com
PERMIT NUMBER q- _. ( 0 7 y 47 1 — 5 a '‘ _TAR�iET DATE 2
SITE ADDRESS SUITE/UNIT•
3LCOO—A &h1 LhiStn) WAN , V4ik CtbO214,A
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL 0
$ 43 DO,Q' N-17,00 12 3_ 2 t d - q S2 2 4.
TYPE OF PERMIT IcIZILDING 0 PLUMBING 0 MECHANICAL 0 DEMOLITION 0 ENGINEERING 0 FIRE PREVENTION
NAME OF PROJECT (s4( r{,R,O R Lime-r, Al b LIF-4O
I to Romt GOirtkaE 1410ilbt61 .17144,
PROJECT DESCRIPTION POU
I `1 p
•Detailed description of work to r t U Af 014 (9 )L 1 (DiG.PCf�.J'c(Att .L
be included on this permit only 'Q, - l--, 6-6 a •
NAME PRIMARY PHONE
M1KROC& L& l-k t t, L-)--At.t O 1-1-C 2.6-3-"!o4-6147
PROPERTY OWNER
3Go9TaAILITT r"'4 FL 6114 WACC- Ff it-I-t
ZIP
c FE-MAL WAN vi RoO2 3 6cActmr,ger
PROMS
141E-)q)5 ',rub(o l IOL. tivii v
DAUM ADDRESS
CONTRACTOR 0Pe4 AL iic A(3 tt• "
i(uei 1 . E.t4tN4US
CITY STATE ZIP FAX IrObt 0.COM
WA STATE CONTRACTOR'S LICENSE• EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE•
10406ST 0,30i Nl,(o 'I, /VI' / lc!
PRIMARY PEONS
NATIN'VE N .X 05 ' cUt to j it-t6
ADDRESS / EMAIL
APPLICANT• MAILING5 hit A P�,A n51 g) 5Aym
CITY STATE ZIP FAX
•
NAME PRIMARY PHONE
PROJECT CONTACT tILlr ACGIWPIZc1/4-1 ,SAFtc,
rite individual to receive and MAHdN AADDDRREtS(S� �� E-MAIL AAA
respond to all correspondence (J'— �`7 Mc) ) Y'y
concerning this application) CITY STATE ZIP FAX
NAME
PROJECT FINANCING yk.OWNER-FINANCED
When value is$5,000 or more ammo ADDRESS,CITY,STATE,ZIP PHONE
(RCW 1937.095)
I certify under penalty of perjury that I am the property owner or authorised agent of the property owner.I certify that to the best
of my knowledge,the in formation submitted in support of this permit application is true and correct.I certify that I wiU comply with
ail applicable City of Federal Way regulations pertaining to the work authorised 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 encironrnentai laws.
I farther 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 supplied to the city as a part of this ,LA7,* , - . .. I .rt.
` 013IGNATQRE: DATE I 1�� 17
PRINT NAME: WILL 1 A„"1, N1.e ri ,I41, • IL/�
1 ,
Bulletin#100—January 29,2016 Page 1 of 2 k:U iandouts\Permit Application
a *AP _ .
g. Aft -4
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how rnasty of each type offufiure 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(Gus)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
1 I I,,�.c;^ n..,......, 1
� G OF J LVIYIDIIYV`WORK 1
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(KGmhen/Utility) WATER HEATERS(Etecuic(
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
h10 Li.t .bkPuEI-4 LAK,t,RAM 4 $ t4As
EXISTING/PREVIOUS USE LOT SIZE(In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
kVO`E`Do/0 t i ' ?A. G 0 Yes,X No 0 Yes X No
RESIDENTIAL — NEW OR ADDITION l
AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
�^BASFMENTF�^^r- «�... ?, "trt'-'--.., tw ,..,---- t..e ,ew. .,...t'....,.. ';',g—rw
FIRST FLOOR(or Mobile Home)
S,Y iv'''''''''''''
r 1'bk.' ' ;.'..,:'.. .4.:',.-i
.+ i.:1: � # '';i.;;,.:-,15
;,,4441,-,0,4® ®0 . t .+ 1c firs % s ^`.^ #P ��•y. �� i''-�x�
COVERED ENTRY
t; 7, :� -
,DECK r t - b +^f'';'.-- '-'4•";11;';' '''S'''
; r:i T Y4K?S'r t `2 i L
_a.,.a..- -,t.. ..._..;S*a..... *'te'n^ -.,'-+o "' . .x'. x- x 3 .:
GARAGE 0 CARPORT 0
..Ft-»� v,:,fi,r_��'�s p )r. 10 ,i:::.; r1,i••' Sr�x� - ,�3�.;*�a �F ?s¢':' y"�.Y» ,;.
Area Totals PROPosW TOTAL
ESTIMATED SELLING PRICE$ I #OF BEDROOMS
COMMERCIAL—NEW/ADDITION
Area in Construction #of
AREA DESCRIPTION Square Feet Occupancy Groups) Pe Stories Additional Information
t 3.a +r k -ii ? i" ` r 's, IS r• -,J i i t •,6- ,`� .s '.; n 1 . •4Fs�t,.<-{ -�1
•';`,'''- '
�� RN;; of Y p .t'R� v .',•ri ;y ' Y v ♦ 1 >a f f .
n�`r ... t'::;ar, . '.t: �1-74,1:9',,,''' _ ,"''. trr c .. .. �_..y� . , .. >i... <. _ _‘i4.3.1 ..t.Sr,.,._..,,ct„,,,_-.. ,..,,,c1 4
ADDITION
COMMERCIAL-REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area Occupancy Group(s) Construction #of Additional Information
Square Feet Type Stories
r'" 4!` r R.-.,• : \l s a :::-*, -;';',e.4.i-770;;-:'"- °�r 1 L
j"` ' ' 3i b' ,it a. ' ¢#SOT I r G �" {.r r `r s$ - � _sr -,,—,-•-•-',.-I-• afi7-"Pyr. -4-,'I.._z. .. .e .r , . ?,_Ztr1_k: , iv,..I.x, ._. ...? acE!� t '.'` ' ,. L. .. _,, . _' ._: , _ '': 1."'-,=,-..,
TENANT AREA ONLY
4PROJECT'ARL t ONLY . 'a#"' .y�,3 x" x',7,,,, t h' ' Yz `ks;^ x r s -'z 5*R .s' '�+.. ,l I
Bulletin#100—January 29,2016 Page 2 of 2 k:\Handouts\Permit Application