20-101642-Building Permit Application-04-24-2020-V1CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenterr(PcitcoffederaINN ay.coin
- TARGET DATE
SITE ADDRESS
J
SUITE/UNIT#f
PROJECT VALUATION
$
ZONING
ASSESSOR'S TAX/PARCEL #
L+d.00()
K-3
- �3 �G - D C�
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
ft4:> VTI ON To KES ✓OA- 5cr2
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
�-lo c1 5alesh�-.� Gr,gr,
PRIMARY PHONE
PROPERTY OWNER
20� • I-t65 •moo
MAILING ADDRESS
2 p s L g
E-MAIL
�.v1 A� C rC� aid .
CITY
STATE
ZIP
NAME
Sed Owner
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE #
EXPIRATION DATE
FEDERAL WAY BUSINESS LICENSE #
NAME
'•mow � i�V v �./
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
R p J . �, o 4en
PRIMARY PHONE
2S3 gl4 2
(The individual to receive and
respond to all correspondence
MAILING ADDRESS G1 l
2 S.�(o� I SU�Te- —3
E-MAIL
rn0' Y n GOr1��
concerning this application)
CITY
�Qale,ra�
ZIP
`t�W3
FAX
--LSTATE
W a
�
PROJECT FINANCING
NAME I 04Mer
,{
�I OWNER -FINANCED
When value is $5,000 or more
(RCW ]9.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
� 6HF ✓✓ DO
I cerunder penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that
tify to the best
of my knowledge, the information submitted in support of this permit application is true and I
correct. 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.
1 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 the city asap this application.
SIGNATURE:
DATE
/�
PRINT NAME: _ L CA a✓I
9,
C-0m
Bulletin # I00 — January 29, 2016
Page I of 2
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MECHANICAL PERMIT VALUE OF MECHANICAL WORK
Indicate how manm of each t e o re to be inst lied or relocated as Part of this proiect. Do not include existigg flxtures to remain.
AI DLING UNITS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDIT FIREPLACE INSERTS HOODS (commerciat)
BOILERS FURNACES r HOT WATER TANKS (Gan)
COMPRESS GAS LOG SETS I REFRIGERATION SYST
D G S PIPING WOODSTOVES
PLUMBING PERMIT
Indicate how many of each ty, e of fixture to be installed or relo,
BATHTUBS (or Tub/Shower combo) LAVS (}land Sinks)
DISHWASHERS T RAINWATER SYSTEMS
DRAINS ✓ SHOWERS
DRINKING FOUNTAINS SINKS (Kitchen/Utility)
HOSE BIBBS SUMPS
pf, this project. Do not in
TOILETS
URINALS
VACUUM BREAKERS
WATER HEATERS (Electric)
WASHING MACHINES
VALUE OF PLUMBING WORK
IgJwMres to ren
WATER PIPING
OTHER (Describe)
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 J�r No
RESIDENTIAL - NEW ORXi
AREA DESCRIPTION (in square fee
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
ti
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
EXISTING PROPOSED TOTAL
3�
Area Totals I EXISTING
**NEW HOMES ONLY**
PROPOSED I TOTAL
FOR OFFICE USE
............. .............................
COM IAL — NEW/ADDITION
AREA DESCRIPTIO
Area in
uare Feet
Occupancy Group(s) s
P y p(1
Construction
Type
# of
Stories
Addi nformation
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENA>IMPROAREA
DESCRIPTION
`rea In
Feetup(s)
ruction
Typ
# ofuare
Stories
Additional Information
TOTAL BUILDING
TENANT AREA
JECT AREA ONLY
1
Bulletin # 100 — January 29, 2016
Page 2 of 2
k:\Handouts\Permit Application