20-104455-MF-BuildingPermitApplication-11-12-2020-V2C)V1 l c c+ �i 2 n -- I 0 JA c-5- e6ah'on i c s u_ r ,(w C� e4) a4lra-iw&q
1 1�k PERMIT APPLICATION �
CITY OF .
PERMIT CENTER + 33325 Bch Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
PERMIT NUMBER 16 _ 1 � �
- --- � �- � � •� _ � - TARGET DATEAW
SITE ADDRESS SUITE/UNIT #
13 15 1 42 4� 6 7-3 Fe
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL #
$ (0000 �J 111 - j (a - (r- - L o - 3 4 o
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
VIP -
PROJECT
PROJECT DESCRIPTION
Detailed description of work to
�Jl i+, 1C71 'r �,l�C ^P , 4o
be included on this permit only
NAME
of 1 VeAl
PRIMARY PHONE`` p
PROPERTY OWNER
MAILING ADDRES
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-
8-4-� C` � e� Q S �
E-MAIL
► ACLO-L . elareA_kk �
C Y
e�e�l
STATE
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ZIP
98bZ3
QA
NAME I
r 15 -p,_Q-Vn 6C6- i nck
PHONE
26(o 2A6--G_+6l
MAILING ADDRESS I
4 -5 tiE
E-MAIL
CONTRACTOR
CITY C\
ZIPSFAXIsM
WA STATE CONTRACTOR'S LICENSE #
_" SR Z 125 S S
EXPIRATION DATE
04 Zr7Z
UBI #
LoOl -o -�-Gas
NAME
9
PRIMARY PHONE
MAILING ADDRESS
E-MAIL
APPLICANT
CITY
STATE ==
FAX
PROJECT CONTACT
NAME `�'
.-1
PRIMARY PHONE
"ZD (p °--20&- (oq(P 1
MAILING II ADDRESS �jI
1 `'� Z 'l LS
,ry J
. a e_ S V V
E-MAIL
% e't C CAWV..l , C07✓L
(The individual to receive and
respond to all correspondence
CITY `
-A-P -r0�
STAT ZIP.
W l $ o
FAX v
OWNER -FINANCED
concerning this application)
PROJECT FINANCING
NAME �(
I V A
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESSI, CITY, STATE, ZIP
PHONE
2Oip -9 +3 p 'j
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certifythat 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 R this application.
1 7
SIGNATURE: DATE �_/1 Z-6
PRINT NAME: YY► C] CSL�
727M
Bulletin #100 -February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT
Indicate how marry ofeach type of
fixture to be insta a or rel
AIR HANDLING UNITS
FANS
AIR CONDITIONER
FIREPLACE INSERTS
BOILERS
FURNACES
COMPRESSORS
GAS LOG SETS
DUCTING
GAS PIPING
PLUMBING PERMIT
Indicate how Many of each t �e offixture
to bd installed or relm
BATHTUBS (or rub/Shower eomho)
LAVS (Hand sinks)
DISHWASHERS
RAINWATER SYSTEMS
DRAINS
SHOWERS
DRINKING FOUNTAINS
SINKS )wtone /U,wty)
HOSE BIBBS
SUMPS
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR
EXISTING/PREVIOUS USE I LOT SIZE (In Square Feet)
RESIDENTIAL - NEW OR ADDITION
VALUE OF MECHANICAL WORK
this prajeGL Do not include existingfixtuiw to rem
GAS PIPE OUTLETS OTHER (Describe)
HOODS (e000mereial)
HOT WATER TANKS (Gas)
REFRIGERATION SYST
WOODSTOVES
VALUE OF PLUMBING IA70RK
as part of this roft-et, Do not include existingfWtuves to remain.
TOILETS WATER PIPING
URINALS 0TH5"escri be)
VACUUM BREAKERS
WATER HEATERS (Eiert,;e)
WASHING MACHINES
SEWER PURVEYOR
EXISTING FIRE SPRINKLER
❑ Yes ❑ No
AREA DESCRIPTION (in square feet)
FXI$ G
O SRD
TAL
BASEMENT
FIRST FLOOR (or Mobile Home)
................
SECOND FLOOR
COVERED ENTRY
......... .
DECK
_......
GARAGE ❑ CARPORT ❑
OTHER (describe)
—
...,..................
Area Totals
"NEW ES
E7USTING PROPOSED TOTAL
ONLY**
ESTIMATED SELLING PRICE $ # OF BEDROOMS
COMMERCIAL - NEW/A DITION
AREA DESCRIPTION / Area in
Square Feet
NEW BUILDING
ADDITION
TOTAL FIXTURES
OF EXISTING IMPROVEMENTS
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
Occupancy Group(s I Construction I # of
p y p() Tgye Stories Additional Information
C:OMMERCIA - REIMODEL/TENANT IMPROVEMENTS
A9DF-SC ON Area in
Occupancy Groups)
S uare Feet
TOT
TENANT AREA ONLY
PROJECT AREA ONLY
Construction f # of
TV + Stories Additional Information
Bulletin #100 —February 19, 2020
Page 2 of 2
kAHandoutsTermit Application
MECHANICAL PERMIT 4 VALUE OF MECHANICAL WORK
(tiVI $
Indicate how many of each type o Ixture to be installe or relocated as art a this ro ect. Do not include existili rxtures 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
PLUMPING PERMIT
Indicate how many or each tI pe of future to U installed or re2vi
BATHTUBS (or Tub/shower Combo)
LAVS (Hand Sinks)
DISHWASHERS
RAINWATER SYSTEMS
DRAINS
SHOWERS
DRINKING FOUNTAINS
SINKS (Ki Lahen/Uriligq
HOSE BIBBS
SUMPS
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY? I WATER PURVEYOR
EXISTING/PREVIOUS USE I LOT SIZE (In Square Feet(
RESIDENTIAL - NEw OR ADDITION
VALUE OF PLUMBING WORK
as part of this Tject. Do not include eXiStLW ttNres to remain.
TOILETS WATER PIPING
URINALS OTHE eseribel
VACUUM BREAKERS
WATER HEATERS (El -tie)
WASHING MACHINES TOTAL FIXTURES
SEWER PURVEYOR
EXISTING FIRE SPRINKLER
❑ Yes ❑ No
OF EXISTING IMPROVEMENTS
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
AREA DESCRIPTION (in square feet)
I01IB
RO SED
TAL
BASEMENT
V110
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
........... .
COVERED ENTRY
DECK
_........ ....... ...
GARAGE ❑ CARPORT ❑
OTHER (describe)
.... ..........
EXISTING PROPOSED TOTAL
Area Totals r'
**NEW 1f Es 01VLY**
....................
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL - NE WIA DITION
AREA DESCRIPTION Area in Occupancy Group(s)
_Square Feet
NEW BUILDING
ADDITION
COMMERCIA '- REMODEL/TENANT IMPROVEMENTS
AREA DESC ION Area in
8 uUaft Feet Occupancy Group(s)
TOTAL HUILD G
TENANT AREA ONLY
PROJECT AREA ONLY
FOR OFFICE USE
Construction I # of + Additional Information
Construction # of Additional Information
TV I Stories
Bulletin #100 - February 19, 2020 Page 2 of 2
k:\Handouts\Permit Application