20-103698-Building Permit ApplicationBulletin #100 – January 29, 2016 Page 1 of 2 k:\Handouts\Permit Application
PERMIT CENTER 33325 8th Avenue South Federal Way, WA 98003-6325
253-835-2607 FAX 253-835-2609 permitcenter@cityoffederalway.com
PERMIT NUMBER __ __ - __ __ __ __ __ __ - __ __
TARGET DATE _______________________________
SITE ADDRESS SUITE/UNIT #
PROJECT VALUATION
$
ZONING ASSESSOR’S TAX/PARCEL #
____ ____ ____ ____ ____ ____ - ____ ____ ____ ____
TYPE OF PERMIT □ BUILDING □ PLUMBING □ MECHANICAL □ DEMOLITION □ ENGINEERING □ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
PROPERTY OWNER
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP
CONTRACTOR
NAME PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
WA STATE CONTRACTOR’S LICENSE # EXPIRATION DATE
/ /
FEDERAL WAY BUSINESS LICENSE #
APPLICANT
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAME PRIMARY PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
PROJECT FINANCING
When value is $5,000 or more
(RCW 19.27.095)
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 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 of this application.
SIGNATURE: DATE
PRINT NAME: ____________________________________________________________________________
PERMIT APPLICATION
Bulletin #100 – January 29, 2016 Page 2 of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT VALUE OF MECHANICAL WORK
$
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
______ AIR HANDLING UNITS ______ FANS ______ GAS PIPE OUTLETS ______ OTHER (Describe)
______ AIR CONDITIONER ______ FIREPLACE INSERTS ______ HOODS (Commercial) _____________________
______ BOILERS ______ FURNACES ______ HOT WATER TANKS (Gas) _____________________
______ COMPRESSORS ______ GAS LOG SETS ______ REFRIGERATION SYST
______ DUCTING ______ GAS PIPING ______ WOODSTOVES
PLUMBING PERMIT VALUE OF PLUMBING WORK
$
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
______ BATHTUBS (or Tub/Shower Combo) ______ LAVS (Hand Sinks) ______ TOILETS ______ WATER PIPING
______ DISHWASHERS ______ RAINWATER SYSTEMS ______ URINALS ______ OTHER (Describe)
______ DRAINS ______ SHOWERS ______ VACUUM BREAKERS _____________________
______ DRINKING FOUNTAINS ______ SINKS (Kitchen/Utility) ______ WATER HEATERS (Electric) _____________________
______ HOSE BIBBS ______ SUMPS ______ WASHING MACHINES ______ TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
$________________________
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM?
Yes No
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 EXISTING
PROPOSED
TOTAL
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $_________________________ # OF BEDROOMS ___________
COMMERCIAL – NEW/ADDITION
AREA DESCRIPTION Area in
Square Feet Occupancy Group(s) Construction
Type
# of
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