20-102060-Building Permitf
PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
TARGET DATE !O / / 20
SITE ADDRESS l` k �, AG f �400�
SMITE/UNIT#
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
LA
TYPE OF PERMIT
W13UILDING ❑ PLUMBING ❑ MEcHAmcAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of ujork to
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be included on This permit only
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NAME ,may "tea ( r GA'�\� e �-- �--^�� W6.t f
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PRIMARY NE
PROPERTY OWNER
KAILD,IG ADDRESS
E-MAIL
CITY
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NAME �. `�
ONE }o �._
MAILING ADD
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CONTRACTOR
CITY(C
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ZIP eo; /7 7
FAX
WA STATE
IRATION DATE
UBI #
R'X-T M9
S
NAME JKI
tp�
PRMARY PHONE
MAILING ADD �(
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APPLICANT
CITY
STATE
ZIP
bV'W
FAX
NAME
PRIMARY PHONE
G
PROJECT CONTACT
dA
MAIIMIG ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
FATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
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 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 environmental laurs.
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 supplied t the
part Of this application.
SIGNATURE:
DATE
PRINT NAMZ*
geA"Vos—
M
k
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
$
Indicate how ntany a each e o
mtt to be installed or relocated as
art o this ro'ect. Do not include e) stirs Lxtures to remain.
AIR HANDLING UNITS
S
GAS PIPE OUTLETS
OTHER (Describe)
AIR CONDITIONER
FIRE CE INSE
HOODS (c—erdat)
BOILERS
FURNACE
HOT WATER TANKS (Gas(
COMPRESSORS
GAS LOG S
REFRIGERATION SYST
DUCTING
GAS PI G
WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each pe
ixtrlre to be installed or relocated as
art o this ro'ect. Da not include xis* ixtures to remain.
BATHTUBS (—q-.b/shower combo(
Hand sl
TOILETS
WATER PIPING
DISHWASHERS
R SYSTEMS
URINALS
OTHER (Describe)
DRAINS
>SH
VACUUM BREAKERS
DRINKING FOUNTAINS
(Kwhen/utility
WATER HEATERS (FAeat-)
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?
rG
�0
❑ Yes V No
El Yes �tO
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occ Group(s) Construction
cy
# of
Stories
Additional Information
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area In
S uare Fee
c upancy Group(s)
Construction
a
# of
Stories
Additional Information
TC))Ta jwliz
TENANT AREA ONLY
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