09-104164ECIV
Fe PERMIT
Federal Wa��)7YY7)``rr� TT
COMMUNITY DEVELOPMENT sJKcT,, 2 2 2 O' uAP P L I CAT I O N
253-835-2607- FAX 253-835-2609
J FMFRAI \A/AV
SF MF CO ME EL PL D!f�n
rnq
PROPERTY
SITE ADDRESS
2109 Sw 33
SUITE/UNIT #
ZONING
ASSESSOR'S TAX/PARCEL #
2 3 Z -A-
PROJECT
NAME OF PROJECT
(Tenant or homeowner Name)
S4Fe wP /�/
TYPE OF PERbUT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION El ELECTRICAL El ENGINEERING X FIRE PREVENTION
NEW 6ZE_ A -LAC S 1 er►-i
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PEOPLE
PROPERTY OWNER
NAME
SA PE W A /
PRIMARY PHONE
((/pZ.3) $ 6� &/o
MAILING ADDRESS, CITY, STATE, ZIP
PC &5& ZgOoq
E -MAD.
(] CONTRACTOR ❑ APPLICANT
❑ PROJECT CONTACT
OWNER IS ALSO:
i
NAME
FRc CH/cF QulPmFn»-
!L✓ PRIMARY PHONE
(iB! ) "I - 2 Z
MAILING ADDRESS, CITY, STATE, ZIP
PO flux (05`i 12enMoNo, wA 98073
FAX
(2.f 5t Z- W4Z
CONTRACTOR
WA STATE CONTRACTOR'S LICENSE #
r-I1zceCC. q3��
EXPIRATION DATE
Fy ill
FEDERAL WAY BUSINESS LICENSE #
I`l- `?9-ty7c�z,-��
APPLICANT
NAME
IT r iZc CHitr=F L�VJ1�
PRIMARY PHONE
(Y��) e ye - 2�L�
CITY, STATE. ZIP ,
M^AI_LING ADDRESS, �,Y,
PO 6bX w 1
FAX
( 7: - "(i ?-
PROJECT
PROJECT CONTACT
(The individual to receive and
NAME /
0*&r
PRIMARY PHONE
57Z - 1�
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
(yes' ) 5Z,Z - �6Z
ALTERNATE CONTACT NAME:
60 V06,7-
PRIMARY PHONE
X121 ) 6",?Z -!L2
E-MAIL
PROJECT FINANCING
NAME
OWNER -FINANCED
Required for projects with
MAILING ADDRESS, CITY. STATE, ZIP
PRIMARY PHONE
value of $5,000 or more
(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 environmeyUaL4aws.
I further agree to hold ha less 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 applicatiory.
SIGNATURE:
DATE
PRINT NAME:
Q '1
v
Bulletin #100-4/21/2009 Page 1 of 4 k:AHandouts\Permit Application
0 . f
Indicate number of each type (
BATHTUBS (or Tub/shm-r combo)
DISHWASHERS
_ DRAINS
_ DRINKING FOUNTAINS
HOSE BIBBS
PLUMBING
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 fixtures to remain.
AIR HANDLING UNITS
FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS HOODS (commeo w)
BOILERS
FURNACES HOT WATER TANKS (case
COMPRESSORS
GAS LOG SETS REFRIGERATION SYST
DUCTING
GAS PIPING WOODSTOVES
Indicate number of each type (
BATHTUBS (or Tub/shm-r combo)
DISHWASHERS
_ DRAINS
_ DRINKING FOUNTAINS
HOSE BIBBS
PLUMBING
FIXTURES
to be installed or relocated as part of this project. Do not include
LAVS (nand sinks)
TOILETS _
RAINWATER SYSTEMS
URINALS _
SHOWERS
VACUUM BREAKERS
SINKS (Kitchen/ut0ay)
WATER HEATERS (FJectrtc)
SUMPS
WASHING MACHINES
( fLrtures to remain.
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
to 3 0?
Additional Information
NEW BUILDING
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
( ; Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
BASEMENT-- --__._.._-..._-........ _........................................._..._- --------
FIRST FLOOR (or Mobile Home)
.... _.....
__...-------
....... ................ _._.._.......... _............. _...
---
SECOND FLOOR
COVERED ENTRY -----------
DECK
........................... _.................. _._...... _.................................................. ............. _...... .... ...................................... ..-_.
GARAGE ❑ CARPORT ❑
............. .............. .............. .............................. ............. ............... ............. ........... ..... _.........
..........._.._
OTHER (describe)
a........................................................................ .............................. ........
Area Totals �G PROPOSED TOTAL._.__.._...
"NEW HOMES ONLY—
ESTIMATED SELLING PRICE I # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area
in Square Feet
Group(s)
Construction
TypOccupancy
a
# 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:ulandouts\Permit Application