21-100246-Building Permit Application-01-22-2021-V14%L
CITY OF F PERMIT APPLICATION
PERMIT CENTER + 33325 8tn Avenue South + Federal Way, WA 98003-6325
Federal Way
253-835-2607 + FAX 253--835-2609 + permitcentel@cityoffederalway.cola
PERMIT NUMBER
SITE ADDRESS
o
PROJECT VALUATION
$ 53t S-(7- d o
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 $5,000 or mare
lRCW IQ270os)
TARGET DATE
/L`, ke� :S SUITE/UNIT #
ZONING k l iA
ASSESSOR'S TAX/PARCEL # iv i
s-( ?r��_nc�r�
Yi-$UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DF-moLI'l'ION ❑ ENGINEERING ❑ DIRE PREVENTION
NAME
M u rJ k
MAILING ADDRESS
1-v C.
c eo,eru�a-L 6LAtL
NAME
MAILING ADDRESSjt� I .
RUN
LL C— PRIMARY PHONE
4T 0 E-MAIL
g nc� ZU
WA STATE CONTRACTOR'S LICENSE #
NAME
-�..�� c-L�► .Z � C� IBC
� s
1
i ADDRESS
0 --,(.j ) (. 4-1-
NAME
MAILING ADDRESS, CITY, STATE, ZIP
- Z4 7- d 45"g
E-MAIL
I -,A id
Q14� FAX
ifZ-U7-5o16 , C.S
EIIPIRATION DATE UBI #
PRIMARY PHONE
z - zD�
E-MAIL
05
PRIMARY PHONE
Swig- AS 05 7
E-MAIL ^ ,�F//►7►1rwi�i rL��.
FAX
❑ OWNER -FINANCED
PH0
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 sapport 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: f lr l\ 0—, DATE 1 ZD Z
PRINT NAME: I ` rmuaS-t-
Bulletin 4100 - February 19, 2020 Page 1 of 2
k:IHaudoutsiPerulilApplIcation
MECHANICAL PERMIT N(pr
Indicate how »Ian of -each e o inure to be insWled or re;
AIR HANDLING UNITS FANS
AIR CONDITIONER FIREPLACE INSERTS
BOILERS FURNACES
COMPRESSORS GAS LOG SETS
DUCTING GAS PIPING
PLUMBING PERMIT N()4
Indicate how man 2t each type o fixture
to be installed or relo.
BATHTUBS (_ Tuh/Shower Combo]
LAVS [Head s xe}
DISHWASHERS
RAINWATER SYSTEMS
DRAINS
SHOWERS
DRINKING FOUNTAINS
SINKS (mtchen/utility)
ROSE BIBBS
SUMPS
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? mATF.D Ibrrvmorr
as art o this ro'ect: Do not it
GAS PIPE OUTLETS
HOODS (commercial)
HOT WATER TANKS iGas)
REFRIGERATION SYST
WOODSTOVES
VALUE OF,A/IECHAWCAL WORT{
g futures to rem
OTHER (Describe)
VALUE OPPLUMBLVr, WORK
as part o this project. Do not include
TOILETS
URINALS
VACUUM BREAKERS
WATER HEATERS (lean;,)
WASHING MACHINES
19 tares to ren
WATER PIPING
OTHER (Describe)
TOTAL FIXTURES
SEWER PURVEYOR I VALUE OF EMS TINGI1WPROVEMENTS
EXISTING/PREVIOUS USE LOT 372E (in Square Feat) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
LJA4 ,+�() Os__ Yes ❑ No o Yes No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED
BASEMENT
FIRST FLOOR (or Mobile home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT M
OTHER (describe)
Area Totals I EXISTING I PROPOSED —
*NEW HOMES ONLY**
ESTIMATED SELLING PRICE $ . I it OF
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
S uare Feet
Occupancy Group(s)
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet Occupancy Group(s)
TOTAL BUILDING
!J 5-013
4 V
TENANT AREA ONLY
+
W
C Q
PROJECT AREA ONLY
_ . _ — — _ I k � .
TOTAL
TOTAL
0"v%j6
FOR OFFICE USE
Construction # of
Type Stories Additional Information
Construction # of
e Stories AdditionalInforlllation
Bulletin 4100 -February 19, 2020 Page 2 of 2
k:lHandoutslPcrnut Application