20-102473-MF-Building Permit ApplicationCITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + jwvnii11(01u, ru, ii) 14 EI( );�I�+.�}.,inl
TARGET DATE
SITE ADDRESS
SUITE/UNIT M
Sobv2 P +� S
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
$ '+9, 000
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TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOUTION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
NAME
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PRIMARY PHONE
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PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
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STATE
ZIP
NAME
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MAILING ADDRESS
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E-MAIL
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CONTRACTORlk-oso,
CITY —7
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STATE
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ZIP
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FAX
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WA TATE CONTRACTOR'S ICENSE M
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EXPIRATION DATE
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NAME
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PRIMARY PHONE
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MAILING ADDRESS
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E-MAIL
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APPLICANT
CITY
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STATE
VIA
ZIP
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FAX
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PROJECT CONTACT
NAME
4--^V-4- " Q\C*Law �-
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAMEID roQ4Lr1, �j.�^„Rr
I OWNER -FINANCED
When value is $5, 000 or more
(RC W 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 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 supplied to ti city as a part of this application.
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SIGNATURE: DATE W�
PFINT NAME:
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Bulletin #100 - February 19, 2020 Page I o1'2 k:AI landouts\Permit Application
VALUE OP MECIIANICAL WORK
MECHANICAL PERMIT
Indicate how many of each type offulure to be installed or relocated as part of this project. Do riot include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE. OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS
BOILERS FURNACES HOT WATER TANKS (cas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
C)
$
Indicate how many of each type orfixture
to be installed or relocated as
part of this ro'ect. Do not include existing fixtures to remain..
BATHTUBS (or9'ub/Sho—Combo)
LAVS (irandSin s)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kim,,/Utility)
WATER HEATERS (El-tnc)
HOSE BIBBS
SUMPS
WASHING MACPIINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
Y--
EXISTING/PREVIOUS USE
LOT SIZE tIn Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
I I Yes r.a No
i 1 Yes rI No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE
... .... ... ..........._............. ............. .......
.
BASEMENT
.................................................................. ........ .......................................... ...... ..... ......... ............................... I............ .....
FIRST FLOOR (or Mobile Home)
.............._....... ................ ........ .,,.,,.,... ,.,............. ...... .........,,..... ,..................... ,........... ... .......... ..... .....................................
SECOND FLOOR
.....................................................................................................................................................
COVERED ENTRY
................................................................
DECK
.............................................................................................................................................................................................
GARAGE ❑ CARPORT ❑
OTHER (describe)
............................................................................................................ .................................... ,................................
.
Area Totals EXISTING PROPOSED TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ _ # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL- REMODEUTE.NANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
BUlletin # 100 -- February 19. 2020
Page 2 of 2
Ul landouts\Permit Application