09-104020�� � )4&ECE'.J 2 -
CITY OF
Federal WayDC-f 1,3 '601 PERMIT SF MF 0
COMMUNITY DEVELOPMENT SERVICES
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6
PROPERTY
_
SITE ADDRESSX11�j
SUITE
ZONING
ASSESS 'S TAX/PARCEL # - --`� —
�r/'1 Z
PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name)
/' Zi
❑ BUILDING ❑ PLUMBING MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION
PROJECT DESCRIPTION
■ �n s.
Detailed description of work to
be included on this permit only
IN
PEOPLE
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS, CITY S ATE, ZIP
E-MAIL
OWNER IS ALSO:
CONTRACTOR APPLICANT PROJECT CONTACT
N
�2,l,jj A
PRIMARY PHONE
)-3� .2 3
CONTRACTOR
MAILING ADDRESS, CITY, STATE, ZIP r
FAX
WA STATE CONTRACTOR'S LICENSE #
�))L ,���� � `�� =? � T
EXPIRATION DATE
r t / 36 o()
FEDERAL WAY BUSINESS LICENSE #
.4PAlea Ab /-
RAMP,
PRIMARY PHONE
APPLICANT"`
MAI Q ADDRESS. CITY/. STATk7tP r
FAX
PROJECT CONTACT
NAME
e
'ts L`�
PRIMARY PHONE
(The individual to receive and
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
ALTERNATE CONTACT NAME:
PRIMARY PHONE
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)
Towner. II
I certify under penalty of perjury that I am the property owner or authorized agent of the property 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 clot ou a reliance of the city, including its officers and employees, upon the accuracy of the
information supplied t city as a part is application.
DATE
SIGNATI
PRINT NAME:
Bulletin #100 - 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
,MECHANIIS4L
FIXTURES
Value <)f Mechanical Work
G COPY OF BID OR ESTIMATE MUST BE PROVIDED)
Indicate number of each hffle of fixture 14b&
installed or rerocat
as part of this project. Do not include extsth-kqAlures to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (commarctap
BOILERS
FURNACES
HOT WATER TANKS (Gas)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
Indicate number of each type c
BATHTUBS (ornb/shower Combo)
DISHWASHERS
DRAINS
DRINKING FOUNTAINS
PLUMBING
FIXTURES
fixture to be installed or relocated as part of this project. Do not include
LAVS (hand sinks)
TOILETS
RAINWATER SYSTEMS
URINALS
SHOWERS
VACUUM BREAKERS
SINKS (H tohen/Uauty)
WATER HEATERS (Eieomo)
SUMPS
WASHING MACHINES
i fixtures to remain.
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
RO.]ECP VALUATION Apc:>
i.
GENERAL INFORMATION
WATER PURVEYOR SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
E f G
LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes ❑ No
RESIDENTIAL
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
^T
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
----�
Area Totals
naiexwa
enososeo
TOTAL--
"NEW HOMES ONLY""
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area Construction # of
Occupancy Group(s) Additional Information
_ in Square Feet Type Stories
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Additional Information
in Square Feet
a
Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — 4/21/2009 Page 2 of 4 k:\Handouts\Permit Application