20-101533-Building Permit Application-04-09-2020-V1CITY OF _.,� PERMIT APPLICATION
Federal Way PERMIT CENTER +33325 81hAvfmue South + Federat Way, WA 98003-6325
253-835-2607 + PAX 253-836-2609 + �ennitcentet rrrir� offecler xiwav Qom
PERMIT NUMBER _
TARGET BATS
SITE ADDRESS
SUITE/UNIT �
PROJECT VALUATION 7iOHING ASSESSOR'S TAX/PARCEL #
_30
Ci
TYPE OF PERIIIIT ElBUILDING Q PI,UNMJNG ❑ MECHANICAL
Ie1JEMOLITION 0 ENGINEERING ❑FIRE PREV'EN"FION
NAME OF PROJECT I kol- 11. fi r"\ /'�'
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
Whsn value is $5,000 or More
(RCW 19.27- ass)
NAME
MAILING ADD=
ci
MAD.DiO ADDRESS
CITY
WA MTATE [C-OXfMACTOy.R'S LICE
NAME
WAIT ING ADDRESS
l 6 �- of "5", )" I eA
KAMIZ R.-
s't
MAM-- ADDRESS_
NAME
MAILING ADDRES6, CITY, STATE, zip
r
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71TATE Z
'`_TFs i Pam? i
211PIRATION DATE
t.-Avg- )'0-1r�
STATE JUA Z -9Sv---,-, 7
PRIMARY PHONE
!af , tea] 4 i�ii' V
IFAX
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nRAL WAY 8
WYA
PRIMARY PHONE
E-MAIL
_l ,.-a -P,a f f")
PRIMARY PHONE
E-MAIL
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FAR
OWMR-FINANCED
PHONE
I certifg under penalty of perjury that I am the property owner or authorized agent of the pro e of my knowledge, the information submitted ins support o this P riy owner. I that
that t0 the best
all applicable Cityo Federal W uPP ,f permit application is true and correct. I certify that i will comply with
f ay regulations pertaining to the work authorized by the issuance of a permit. I understand that the
issuance of this permit does not remove the owners 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 t the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a part o is application.
SIGNATURE Y !
DATE
PRINT NAME: rN r s p
Bulletin 4100 — January 29, 20,16 Page 1 of 2
k:11-IandoutslPernrxit Application
•n
MECHANICAL PERMIT
Indicate scow Titan or each tyE
AIR HANDLING UNITS
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
V-4LVE OF MECUM NICAL WORK
r vdure to be installed or relocated as
Vart o this pro'ect. Do not include
FANS
GAS PIPE OUTLETS
FIREPLACE INSERTS
_
HOODSIco ,,,ij)
FURNACES
HOT WATER TANKS IoA:
GAS LOG SETS
REFRIGERATION SYS'i'
GAS PIPING
WOODSTOVES
9 Pxtu res to rem
OTHER (Desciibe�
PLUMBING PERMIT ��VALUEOFaUMBINC,WOR(�
Indicate hoc" mwc o each o lo
re to be bstalled or recated as o this ro " ct. Do not incihude fn to res to re,-,
BATHTUBS (_T�,,/sharvacomhe) LAVS pi_aS_k,4 TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS
DRAINS SHOWERS VVACUUMQREAKERS OTHER (Describc)
DRINI{ING FOUNTAINS SINKS Ix t henfuti&ty) WATER HEATER'S
HOSE HIBBS SUMPS WASHING MACHINES
GENERAL INFORMATION
CwrICAI. AREAS ON FROPERTY� WATM PUR
TOTAL FIXTURES
VEYOR SEWER PURVEYOR VALUE OF IMSTING INFROVEffiENTS
EXIBTINE►/PREVIOUS UB�S LO? SIZE �ee1t^^t��Squa[e FBet] E7g8TING FIRE SPVJ==R SYSTEM PROPOSED FIRE SUPPRESSION SYSTEM?
M 115® ❑ Yes KNO 11 Yes rono
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL
BASEMENT
- .....- -..... ------
FIRST FLOOR (or Mobile Homy
--------------------- ---
SECOND FLOOR .........
-...._...._
COVERED ENTRY
—.... —
DECK ---- ------
-- -
_-------------....._
GARAGE ❑ CARPORT C]
-------------_-----
ArHeEaR (dLeosc/riabel)s M. MUMS= TOTAL
*;1MW HOBS ONLY**
ESTIMATED SELLING PRICE
# OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION Area in
care Feet Occupancy Group(s)
11EW �3fI1LDIl4G
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION Area in
Square Feet Occupancy Groupw
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
FOR OFFICE USE
Construction I # of
Stories Additional Information
Construction # of
Stories Additional Information
Bulletin #100 -January 29, 2016 Page 2 of 2
k;IHandotltslPermitApp)ication