20-104282-Building Permit Application-11-05-2020-V141k
CITY OF
Federal Way
PERMIT NUmmm
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentera@cityoffederalway.com
— -- -- TARGET DATE
SITE ADDRESS
SUITEMNIT li
PROJECT VALUATION
ZONfNG
ASSESSOR'S TAXI PARCEL ii
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
VAO I•A f;?5 a--e I W6(9APt---
l d; L-'
PROJECT DESCRIPTION
Detailed description of work to
�� ����
1 W P 5 61-�( O
MP _S JA CPIW N S
be included on this permit only
A C�4s� e �rrr� L�LiP-iG -
L ' 't�ifiLGtiai
NAME j" T FMW-r= AtJD i
PRIMARY PHONE
1 C n CAW
��
•cj'/3 ' �`� "S'Cl�&z-
PROPERTY OWNER
MAIL ADDRESS
3Z2 h S
l4— NdSI� n%ITA-
CITY II++{l
W
STATE
4
IPZIP
NAME
PHONE
MAILING ADDRESS
E-!TAIL
CONTRACTOR
2
S}i49AC
CITY
STATE
U) Q
ZIP
610)oQ
FAX
WA STATE CONTRACTOR'S LICENSE /
EXPIRATION DATE
UBI Y
NAME
.s -5HN A"
PRIMARY PHONE
2q3 3 �.3ofl
APPLICANT
MADDiGAD
G
CN
11C�4H
�kIL.Sjjlti
CITY 4 A
7y C- ilkA-
STATE
W A
ZIP
q
u
FAX
PROJECT CONTACT
NAME
SIFF6r� 7gft1 1'j
PRIMARY PHONE
Z - , Z2 C1 {�
MA WO ADDRESS
'zl
R -MAM j5p�"T'V-r Q t I N
@%1c '
(The individual to receive and
respond to all correspondence
WA AN �.(=FSm
CITY
STATE
W Ar
ZIP
41 Pao 2
FAX
concerning this application)
PROJECT FINANCING
NAME pmrC4 4V-LTfj
OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
!SAILING ADDRESS, CITY, STATE, ZIP
Z� -�(�" :; *V A4r-
PHONE
/ � -72 , 'r if „
+/
Ii&
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert that too 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 ofthis application.
-t
SIGNATURE: rjl DATE 0e, I -✓d
}
PRINT NAME: {'
M
Bulletin 4100 - February 19, 2020 Page I of 2 k:lHandoutsTermit Application
MECHANICAL PERMIT
VALUE OF MECHANICAL WORK
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS �commemv�
BOILERS
FURNACES
HOT WATER TANKS (Go)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
PLUMBING PERMIT
VALUE OF PLUMBING WORK
Indicate how manyi of each type.o inure to be installed or relocated as
part o this project. Do not include eldstinq fixtures to remain.
BATHTUBS(orrub/Sh rCombo) LAVS (Noed sw)
DISHWASHERS RAINWATER SYSTEMS
DRAINS SHOWERS
DRINKING FOUNTAINS SINKS pato /uatn
HOSE BIBBS SUMPS
TOILETS WATER PIPING
URINALS OTHER (Describe)
VACUUM BREAKERS
WATER HEATERS (meant)
WASHING MACHINES TOTAL FDtTUREN
GENERAL INFORMATION
CRITICAL AREAS OF PROPERTY?
WATER PURVEYOR
SRWER PURVEYOR
VALUa OF AKIN= DIPROVEMRNTS
EMOTING/PREVIOUS USE
LOT SIZE (In Sq.. Feet)
SKIRTING FINE SPRINKLER SYSTEM?
❑ Yes ❑ No
PROPOSED FINE EUPPRESSION SYSTEM
❑ Yes ❑ No
RESIDENTIAL - NEW ORADDITION
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
PROPoRRn
TGVD,
.-NEW ROAM ONLY""
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area inSto
Occupancy Group(s)
Construction
# of
Additional Information
S are Feet
a
ries
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area. in
Occupancy Group(s)
Construction
N of
Additional Information
Square Feet
a
Stories
TOTAL BuiLDmo
(PIS
t�, UCCU�I1G�
III-E N Ktfy
2
TENANT AREA ONLY
U
PROJECT AREA ONLY
':Ij (fits
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Hmdouts\Pemut Application