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09-103914REI V iZS �s CITY OF OCT 01 2009 PERMIT Federal Way ''s� commugy DEVEf=y2, c�E FE©EKP'' � ICATION 253-835-2I F 3 3 -26 C i wunv.cituoffederaitvau.com CDS N �- II -31Ll- /_ SF MF CO ME EL PL DE EN P PROPERTY SITE ADDRESS SUITE/UNIT # ZONI G ASSESSOR'S TAX/PARCEL # PROJECT =OL NAME OF PROJECT (Tenant or Homeowner Name) Q (Ic cv_ �_CCS05 7 �r� "c )12 S LC ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING/FIRE PREVENTION ADD PROJECT DESCRIPTION 1 111 .�` t L-10 •� (l Detailed description of work toMCEhJ be included on this permit only 7,_ PEOPLE, PRIMARY PHONE NAME PROPERTY OWNERJFC !`,=T - MAILING ADDRESS, CITY, STATE, ZIP E-MAIL OWNER IS ALSO: ❑ CONTRACTOR ❑ APPLICANT ❑ PROJECT CONTACT NAMEPPt�MY V_C'v � PHONE �7 MAILING ADDRESS, CITY, STATE, ZIP ' S1-1 k�T� �t� �i'���3a FA% (253 )8 T7 CONTRACTOR WA STATE CONTRACTOR'S LICENSE # EXPIRATION DATE FEDERAL WAY BUSINESS LICENSE # k1le-C-tel IV 110 OF__ I /Zell ao--co -- ie ( `tb-5 - cc- . NAME _ IVS PRIMARY PHONE ( u - APPLICANT MAILING ADDRESS, CITY, STATE, ZIP FAX PROJECT CONTACTNAME- — J �'- C N- �- PRIMARY PHONE E 'r;yc •f i2 (lice individual to receive and (� ) - .A MAILING ADDRESS, CITY, STATE, ZIP (y 5� S, ��� S'r FAX respond to all correspondence concerning this application) ALTERNATE CONTACT NAME: �—t PRIMARY PHONE Sf(.LA1Q56? EMAIL (A./A - CHW_(cyUSTAi<CT104), C M4 PROJECT FINANCING NAME ❑ OWNER -FINANCED Requiredforprojectswith MAILING ADDRESS, CITY, STATE, ZIP PRIMARY PHONE value of $5,000 or more (RCW ]9.27.095) 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 reliance of the city, including its officers and employees, upon the accuracy of the information uppI ed to thecit�y7a�s^apart of this application. t ' t SIGNATURE: V " w DATE PRINT NAME: C_ AA Bulletin #100 — 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application COMMERCIAL - NEW/ADDITION MECHANICAL FIXTURES Value o Mechanical Work $ _ (A COPY OF BID OR ESTIMATE MUST BE PROVIDED) Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing futures 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 COMMERCIAL - NEW/ADDITION PLUMBING FIXTURES Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing f trtures to remain. BATHTUBS (or Tab/Sho combo) LAVS (Rand Sinks) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS (Kitchen/Utility) WATER HEATERS (Eiectne) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES Construction Typa # of Stories Additional Information GENERAL INFORMATION PROJECT VALUATION WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? F Yes (i No PROPOSED FIRE SUPPRESSION SYSTEM? ❑ Yes 3 -No RESIDENTIAL AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT TOTAL BUILDING ...... --........ _._......_..... ............. ...................... ---.............. --..... ... __. FIRST FLOOR (or Mobile Home) TENANT AREA ONLY SECOND FLOOR PROJECT AREA ONLY _._._.._.__._..........__._..... _ _.__._ _.._...._...__. . .._.._._ _._._._.._._._..__.—...... COVERED ENTRY ...- ...... -._.._._......... _................ ..... ...... __...... _....... ------_... DECK _ ._ _. _ ._____ GARAGE ❑ CARPORT ❑ OTHER (describe) Area Totals EXISTING PROPOSED TOTAL ................... _-..... _........ .... _................. ...... _._..--- --.............. _........... _... ... **NEW HOMES ONLY** ESTIMATED SELLING PRICE $ 1 # OF BEDROOMS COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction Typa # of Stories Additional Information NEW BUILDING ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction Typa # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Pennit Application