20-101623-Building Permit Application-04-20-2020-V14k
CITY OF
Federal Way
PERMIT NUMBER -4a 048 QO -P!O
PERMIT APPLICATION
PERMIT CENTER + 33325 8'" Avenue South + Federal. Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permiteenteifdcitvoffederalway.com
TARGET DATE
SITE ADDRESS
SUITE/UNIT #
all o K- ��, tvA BSc n3
oG `�
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/ PARC #
9—
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
T
PROJECT DESCRIPTION
Detailed description of work- to
be included on this permit only
NAME
T P
PRIMARY PHONE
9
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
CITY
$TA
Z@
PHONE . I 3-1-1
If,[ F{-r �( W
e AM Ct
CONTRACTOR
CITY
w•r�
STATE
W4
ZIP
A10
FAX
053- 41 1
WA STATE CONTRACTD -S LICENSE /
0AC&AKWOSI MCI
EEPIPATION DATE
77i tt
TEDEItAL WAY BUSINESS LICENSE #
d-! •I - -6�-
N
PRIMARY PHONE
• L170 - P16*1
MADaNG ADDe� k �
�7
E-MAD.
e v
TAX
-2 -"- Ism
APPLICANT
CITY STATE
Wa
ZD'
�
PROJECT CONTACT
NAME
A L
PRIMARY PHONE
H
MAILING ADD
j G ` W
E-KML
D-(&LCWW, &C 40
(The individual to receive and
respond to all correspondence
Cry
STATE
2IP
FAX
25.y7(,_!Sq-qt
concerning this application)
PROJECT FINANCING
NAM
❑ OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS. CITY, STATE, ZIP
PHONE
i
I certify under penalty of perjury that I am the property owner or authorised 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 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 the city as a part o this application.
+-
SIGNATURE: _ DATE �f Q
PRINT NAME: Mxc
EX
Bulletin #100 — January 29, 2016 Page I of 2 k:\Handouts\Pennit Application
V_AL['E OF tiIECHA,YlC'_AL WORK
MECHANICAL PERMIT
In.dieate how Ymmy o each Lqpe of Lv Wre to be installed or relocated as part a tllFx ro' f. Do not include e_t-isti►t Tres to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS, a�
BOILERS FURNACES HOT WATER TANKS ;Ga
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
PLtiMBING PERMIT
V_-ILt'E OF PLf'1181,VG WORK
Indicate how nmn_q of each_ p
jp4e of rwure to be installed or relocated as 2a5 of this projeffL Do not include exIsting fulures to remcrrn.
BATHTUBS LAVS H,., s„k TOILETS WATER PIPING
DISHWASHERS R.AINIVATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS V.ACUUNI BREAKERS
DRINKING FOUNTAINS SINKS z; _new; c,y„•, WATER HEATERS (Et,—,
HOSE BIBBS SUNIPS WASHING MACHINES TOTAL FI]CTURES
GENERAL INFORMATION
CRITICAL ARRAS 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?
- Yes - No
- 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 ❑
I
OTHER (desc 9-1
Area Totals
SMSTING
PROPOSED
TOTAL
--
*'MEW HOMES OAiLY**
ESTIMATED SELLING PRICE 1
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s
p p((
Construction
a
# of
Stories
Additional Information
NEW BUMDDYG
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
_
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BumDING
TENANT AREA ONLY
PRWECT AREA ONLY
Bulletin 4100 —January 29, 2016 Page 2 of 2 V,Handouts'.Pennit Application
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