20-101499-Building Permit Application-04-02-2020-V1'4k
CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 816 Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcsizterrLcitvoffederalway.com
TARGET DATE
BITE ADDRESS
SUITE/UNIT #
Mz SW 35AA.
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
(�
I V O V
T 5 L O — V � 0
/_
TYPE OF PERMIT
Nf,( BUILDING ❑ PLUM13ING ❑ MECHANICAL 0 DFMOLITioN. ❑ ENGINEE,RING ❑ FIRE PREVENTION
NAME OF PROJECT
V`k f
��Y1q WQ�-t
PROJECT DESCRIPTION
Detailed description of work to
I 2, rin ray.
be included on this permit only
NAME
PRIMARY PHONE
o� -�s1 &a
PROPERTY OWNER
MAILING ADDRESS
�ayD^�F S 358
E-MAIL
HI'cXVI,tr�rk� cx110 ea
CITY I f V �n.1 ,� ! 7 '
V!
STATE
Z.IP ! V V o /
{�(��/.� f
NAME i {�` l
� , N�tk1�1PHONE
-a -s a(at-
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
"\O\AVA
STATE
ZIP
2\ %o01
FAX
WA STATE CONTRACTOR'S LICENSE #
ICU Sq �-
EXPIRATION DATE
0� / �1 / "ao
FEDERAL WAY BUSINESS LICENSE #
NAME
11f�0�i� Vi��V11t, �11��.s �,O�S�+ML�i�vt ttvil;�5 l�
PRIMARY PHONE
�Ol�'aS1 r-Sa ��
MAILING ADDRESS
5a o� 5. 5 ++�t •
E-MAIL
i [cvrthr+c@ya�roo cwtic
APPLICANT
CITY
JAVb�AW
STATE
wK
ZIP
�$001
FAX
NAME
PRIMARY'PHONE
PROJECT CONTACT
N\ li\til 1�V iL 5 S� VI YUIi2 1 _ •
;1 (0' `J' 1— S 2 (oLt
MAILING ADDRESS
$ti° SAP
E-MAIL
(The individual to receive and
respond to all correspondenceG
5
tY
CITY
IR V\V A
STATE
WA
ZIP
M 0 1
FAX
concerning this application)
PROJECT FINANCING
NAME
❑ OWNER -FINANCED
When value is ,$5,000 or more
(RCW 19=095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
I certify under penalty of perjury that I am the property owner or authorizedagent 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 (inclruifng costs, expenses, and attorneys' fees incurred in
the investigation and defense of such claim), which maybe made by any perso ✓✓including the undersigned, and filed against the city,
but only where such claim arises out of the reliance of th city, includi its officers and employees, upon the accuracy of the
information supplied to the city as a part of this applicatio
SIGNATURE: DATE 1� 2 D
t( j
iksj PRINT NAME: o tit
Ea
Bulletin #100 — January 29, 2016 Page 1 of 2 k;lHandouts\Permit Application
MECHANICAL PERMIT VAL[IE OF MECFJAWCAL WORK
$ � /r) n C%
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
frxture to be installed or re
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPING
GAS PIPE OUTLETS
_ HOODS (co )
HOT WATER TANKS
REFRIGERATION SYST
WOODSTOVES
_ OTHER (De ribe)
e� q
PLUMBING PERMIT
ddVALUE OF PLUMB GWORK
Indicate how man o each e o v1ure to be installed
or relocated as art o this ro'ecL Do not include existing fixtures to remain.
BATHTUBS (mmb/Sho,, Gambo) LAYS ("ma s;ws) 'a TOILETS
DISHWASHERS RAINWATER SYSTEMS URINALS
DRAINS_ SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS _4— SINKS Xs n/uti to WATER HEATERS finemo
HOSE BBBS SUMPS WASHING MACHINES
WATER PIPING
_ OTHER( Describe)
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
EX[NTING/PREV10Ua USE
WATER PURVEYOR
LOT SIZE (In Sgmre -F..tl
SEWER PURVEYOR
EXISTING FIRE SPRDOO.ER SYSTEM?
❑ Yes ❑ No
VALUE OF EXISTING IMPROVEMENTS
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ 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 ❑
................................... _....................................................
OTHER (describe)
,.
-- . .............
._............................. ......__._...
Area Totals
�� q
a a°2
1 2
_... .........
. _
............ ......-..........
-NEW HOMES ONLY"*
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
AreS uarea In Feet
Occupancy Group(s)
Construction Type
Stories
Additional Information
NEW BUILDING
'
ADDITION
COMMERCIAL - REMODEL/TENANT 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 - January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application