20-102994-APPLICATION41k
CITY OF
Federal Way
PERMIT NUMBER _
SITE ADDRESS
-4" Z, O
PROJECT VALUATION
$ Z0vr0uv
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is S5, 000 or in ore
fRCLti 29.27.095)
PERMIT APPLICATION
PERMIT CENTER + 33325 8f Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(cicityoffederalway.corn
— TARGET DATE
SUITE/UNIT #
1��
ZONING ASSESSOR'S TAX/PARCEL #
D A?_C-5-6U-6L-�-v
*BUILDING ❑ PLUM13ING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING
❑ FIRE PREVENTION
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NAME
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PRIMARY PHONE r
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MAILING
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E-MAIL
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CITY
gSTATE
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PHONE
MAILING ADDRESS
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STATE ZIP
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FAX
WA STATE CONTRACTOR'S 4ICENSE #
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EXPIRATION DATE
UBI #
NAME �
PRIMARY PHONE
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MAILING ADDRESS
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FAX
NAME{��"
PRIMARY PHONE
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MAILING ADDRESS
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E-MAIL
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STATE ZIP if A
FAX
NAME
OWNER -FINANCED
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 Wag 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 apart of this application.
SIGNATURE:
PRINT NAME:
v �-3/)l1l
DATE
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Bulletin ##100 —February 19, 2020 Page 1 of 2 k:lHandoutslPermit Application
MECHANICAL PERMIT
VALUE OF MECHANICAL WORK
Indicate how mOny of each tMee otfixture
to be installed or relocated as
part o this eroLect. Do not include existin res to remain.
AIR HANDLING UNITS
_ FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
_ FIREPLACE INSERTS
HOODS (corouraoleI)
BOILERS
_ FURNACES
HOT WATER TANKS (Goo)
COMPRESSORS
_ GAS LOG SETS
REFRIGERATION SYST
DUCTING
_ GAS PIPING
WOODSTOVES
PLUMBING PERMIT
VALUE OF PLUMBING WORK
Indicate how many of each e o re to be installed or relocated as part o this project. Do not include existin fixtures to remain.
BATHTUBS (or Tab/Sbowm Combo) _ LAVS (Hand Ste) TOILETS
DISHWASHERS _ RAINWATER SYSTEMS URINALS
DRAINS _ SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS _ SINKS (w<men/ud ,) WATER HEATERS �eleowo�
HOSE BIBBS _ SUMPS WASHING MACHINES
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
jAfo-
//WATER�P�UR�V)EYOR
SEWERPURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE 1In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes9<No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes P( 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
EXISTING
PROPOSED
TOTAL
"AFEW HOMES ONLY -
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s) s
P Y p()
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL— REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Typa
# of
Stories
Additional Information
TOTAL BUILDING
^
I 2 -( -5
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2-
TENANT AREA ONLY
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1
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PROJECT AREA ONLY
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Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Hndouts\Pennit Application