19-105090 RECEIVED
PERMIT APPLICATION
/
CITY OF ..
Federal Way OCT 2 3 2019
PERMIT CENTER + 33325 8th Avenue South + Federal Way,WA 98003-6325
CITY OF FEDERAL WAY 253-835-2607 + FAX 253-835-2609 +permitcenter@cityoffederalway.com
COMMUNITY DEVELOPMENT
PERMIT NUMBER I /
/ `l G D 9 (r —! TARGET DATE /
SITE ADDRESS t (. SUITE/UNIT#
-d-o S. ,qo ` -T
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL#
sXI/I/7ev 3 9 -7 C% U - / / 5
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING VMECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT 14S0US S /00. CP-Ya
PROJECT DESCRIPTION
11,) -(--+/,/,
` � R1‘,F4z41-1� 5y5-1-L-4.5
Detailed description of work to
be included on this permit only
NAMEPRI RY PHONE
F. t i y, l e 95,1 - '0g 1./
PROPERTY OWNER MAILING DDRESS E- AIL
50 C /11 4-t COPT
CITY STATE ZIP
114 f Pi 40 )D e (P42�
NAME'7�7r�.."^ /jam Q
.. „i((X/C. ( 5)N i- 33 Y 3
MAILING ADDRESS \H1YI L /
CONTRACTOR 43 2- 1T 6- f Zif 2 a1A4tOQzorea •ten
CITY STATE ZIP r, 719-5)
MJK-i 1--re, 04- ged-r a-t a '015
WA STATE CO 1 gPka LICENSE# EXPIRATION DATE/ 11 L W%YOBU,INES LICENSEft
NAME lX _p/ P AR9Y PPHONEZ 3
- 1-� w ' mss) �17-313
APPLICANT MAILING ADDRESS L
54fine:.>,,..-
a ajW)Phor2Lp,(Gh�STATE ZIPCITY
7;-5).)-1
NAME � D I PRIMARY PHONE
PROJECT CONTACT �i +(L 5 -if 1�p/ �`)C'
(The individual to receive and MAILING ADDRESS E-MAIL
respond to all correspondence
concerning this application) CITY STATE ZIP 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 • to any claim(including costs, expenses, and attorneys'fees incurred in
the investigation and defense of su. claim), which may be ade by any person, including the undersigned, and filed against the city,
but only where such claim a ' e- .ut of the relia o t e city, including its officers and employees, upon the accuracy of the
information supplied to the c' part o tit' ap, .at o .
SIGNATURE: i J DATE I a;h 1
PRINT NAME: k1-470 1/(941-14404
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 Z OTHER(Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS(commercial) 1eEr -�Fdd�S
BOILERS FURNACES HOT WATER TANKS(Gas) L61/P6.191'‘' 6at1W44SC
COMPRESSORS GAS LOG SETS 5 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 C
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 FeetType Stories
NEW BUILDING
ADDITION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in Occupancy Group(s) Construction # 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