09-103217A�CEVEOPERMIT
Federal
COMM 9 uG 1 -•�_ PPLICATION
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SITE ADDRESI rr,
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SUITE/UNIT #
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ASSSESSOR'STA% PARCEL #
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PROJECT
NAME OF PROJECT
(Tenant or Homeowner Name)
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❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
TYPE OF PERMIT
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION
rzovi A A w67- Plum
- 7 E D 1 A) MR Die !2:e 71g igal LSD/ A "J 1D QOn%t
PROJECT DESCRIPTIONT-46
Detailed description of work to
be included on this permit only
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C ANoPIC-S
PEOPLE
NAME
PRIMARY PHONE
PROPERTY OWNER
��] }A /jZK6� {,1/�I
(�5(�S) 400
MADdNG ADDRESS, CITY. STATE, ZIP WbSrLAW V14M
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f I b l:-Q.4 r Cr6w
5 743 Co 2S4 ,A V EAW6 5uau&, CA 513 (,Z
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CONTRACTOR APPLICANT
❑ PROJECT CONTACT
OWNER IS ALSO:
NAME
/a eckc-!L C&N sT M-doT1oN
PRIDSARY PHONE
(tC3) S72,- 72Z7-
MAILING ADDRF_SS, CITY, STATE, ZIP
tx)A 78'a3z
FAX
?Z77
CONTRACTOR
(40)'97z -
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
aKc�4E1�214DR
4 � � izolf
Zo-oo-�01463-na-BL
NAME
PRiMARYPHONE
APPLICANT
ARC *6e Cor,► fL.��Tim�
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MAILING ADDRESS, CITY, STATE, ZIP
NAME
ACP a&L 061,064
FAX
PROJECT CONTACT
PRDNARY PHONE
(253) 872 - 72 zZ
(The individual to receive and
MAILING ADDRESS, CITY, STATE, ZIP
FAX
respond to all correspondence
concerning this application)
(46-3) T72 - 727
ALTERNATE CONTACT NAME:
PRIMARY PHONE
L
17 1
JM y_ )).51 g�M��W^6rfVL1 ,
f+�� Gil
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)
( )
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certVY 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.
Ifurther agree to hold harmless the City of Federal Way as to any claim (including costs, atpenses,
and attorneys' fees incurred
in the investigation and defense
of such claw, which may be made by any person, including the undersigned, and filed against the
city, but only where such a
es out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to t
art application,
"
q
SIGNATURE:
DATE
PRINT NAME:
r�. C014
Bulletin #100 - 4/21/2009 Page 1 of 4 k:\Handouts\Permit Application
Value of Mi
Indicate number of each
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
Work
MECHANICAL FIXTURES
to be installed or relocated as
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPING
OF BID OR ESTIMATE MUST BE
of this project. Do not include ej
_ GAS PIPE OUTLETS
HOODS (commercial)
HOT WATER TANKS (Gas)
REFRIGERATION SYST
WOODSTOVES
fixtures to remain.
OTHER (Describe)
PLUMBING FIXTURES
Indicate number of each type of jba re to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/ShowarCombo) LAVS (Hand Sinks) TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (Kitchen/Utaity) WATER HEATERS (Slcohie)
HOSE BIBBS
SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
PROJECT VALUATION
WATER PURVEYOR SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
3 L L4
LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM?
EXISTING/PREVIOUS USE
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
Yes ❑ No
RESIDENTIAL
AREA DESCRIPTION (in square feet)
BASEMENT
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
EXISTTNO
PROPOSED
TOTAL
"NEW HOMES ONLY"
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL
- NEW/ADDITION
AREA DESCRIPTION
Area
Occupancy Group(s)
Construction
# of
Stories
Additional Information
in uarre�/Feet
NEW BUILDING { [ , D1p Q Z j r-4 V g
`
SI�2 r ry K
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area
Group(s)
Construction
# of
Additional Information
in care Feet
_TyROccupancy
a
Stories
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 - 4/21/2009 Page 2 of 4 k:\Handouts\Pennit Application