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10-101737 � �� _ 10 1 � � � " PERMIT SF MF CO ME EL PL DE EN FP '� Federal Way COMMUNITS'DEVEI.OPMENT SERVICES �j p p L I C AT I O N / / 253-835-2607•FAX 253-835-2609 ❑n4!w.cih o edernl�.com '�a+G O ; �� .� 3�,�� :.� • �� , � . �� . � , . , ,�� 3 yr. �� _,r �. , . �. BITE ADDRE88 .3 �4Zg r��h ,,� SE� .��=', ApR 2 y zo1,o BUITE/UNIT# ZONING ASSEBSOR'S TAX/PARCEL# Z S-O D �-�r1�� FE�r�1A�lv� ,� �- � ;; �� y,. �� , �� ,,_ � ��r�� , „��., - .. ,„ , _ .. .. ��, 3 NAME OF PROJECT `T � (Tenant or Homeowner NameJ +-� �SC�� 1 I ��'-- ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL TYPE OF PERMIT ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING�FIRE PREVENTION �►.`�StY-�� J�..:: v<«.l w " �v..v� �- t��ec1'��,1 PROJECT DE3CRIPTION Cj�e�� e �}�L c�,Nd -K� � �v .wcc��.� �2-a � Detailed description of work to + *� be included on this permit only �}-�l S ( f��-� � �. , ,.„ 'y{y{�� , ., � .: .,., ��.. ,�, „�3.�.�5,,,� '✓��. '�,� '' ��if: }�:i�.�' c i; A., 3 31��aWH kS�.,� �;:,,��, � , '�.. "� �. . '¢ . �,,. .... - . .� . . . .. .: p�$... PRIMARY PHONE PROPERTY OWNER '�C��l`� !(`f� �'`) � E��j L�L—� ��i� ` � �`e MAII,ING ADDRESS,CITY,8TAT ,ZIP �M�T' OWNER IS ALSO: � CONTRACTOR � APPLICANT � PROJECT CONTACT FAbIE PRIMARY PHONE '- R C - r�� Zs3 - l Z`� `� hfAIi.ING ADDRESS,CITY, TAT&,ZIP � F� CONTRACTOR O f ��` ��,,{� � '�' Z S 3 7 3�- C`�)I 3 WA BTATE CONTRACTOR'B LICSNBB EXPIRATION DATE FBDERAL WAY BUBIFE86 LICENSE N �� e L11��og� 4 Z i 3 � i , 0 2 t tQ d t�1 - �3 p�$ PRIMARY PHOAE APPLICANT �� 1 MAII.IN(i ADDRE38,CITY,STATE,ZIP F� 1 � PROJECT CONTACT NAM$ PRIMARY PHOAE (The individual to receiUe and respond fo all correspondence MAILING ADDRESS,CITY,STATE,zir g� conceming this application) - ALTBRNATE CONTACT NAME: PRIMARY PHONH �M�L PROJECT FINANCING �AM$ � OWNER-FINANCED Required for projects with llQlilB Of�$,000 or more �b�G ADDRESS,CITY,STATE,ZIP PRIMARY PHaN$ (RCW 19.27.095J - I certify under penaity of perjury that I am the property owner or authorlaed agent of the property owner.I cerNfy that to the 6est of my knowledge,the information su6mitted in support of this perm{t appZtcatton ts true and cornect.1 cerNfy that I wtll coneply with all applicable City of Federal Way regulations pertaining to the work authortzed by the issuance oj a permit. I understand that the issuance of this perm{t dces not remove the owner's r+esponsibility for compliance with iocai, state, or federal laws regulating construction or envirortmental laws. I further agree to hoid harmiess the City of Federai Way as to any claim(including costs,expenses, and attorneys'fees incurred in the investfgation and defense of such ciairr�, which may 6e made 6y any person, inciuding the understgned, and filed against the city, but only where such claim arises out of the reltance of the city, including tts of,ficers and empioyees, upon the accuracy of the information supplied e city as a part of this applicatton. SIGNATURE: DATE I� PRINT NAME: �(� / �1/�' �`'' Bulletin#100—January 1,2010 Page 1 of 4 k:\Handouts\Permit Application a ` • ' MECHAN�CAL FIXTURES Value o Mechanical Work$ A COPY OF BID OR ESTIMATE MUST BE PROVIDED Indicate number of each type of firture to be installed or relocated as part of this project. Do not include existing fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER(Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS�co�„me�� BOILERS FURNACES HOT WATER TANKS�cas� COMPRESSORS GAS IAG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES PLUMBING FIXTURES Indicate number of each type of f'ixture to be installed or relocated as part of this project. Do not include existing fixtures to remain. BATHTUBS�or Tub/Shower Combo) LAVS�H�,a s��ka� TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINAI,S OTHER(Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS�w��ne�/ua�i�ty� WATER HEATERS(eie«<;�� HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GF.NF,R.AL INFORMATION PROJECT VALUATIOA WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS � �� C� ,,� $ �� L�c� �`-}��-�. � EXISTING/PREVIOUS US& LOT SI2E(In Squere Fcet) EXISTING FI12E SPRINI{LBR SYSTEM? PROPOSED FIRB SUPPR&SSION SYSTEM? ❑Yes�No �Yes ❑ No RESIDENTIAL AREA DESCRIPTION(in square feet) EXISTING PROPOSED TOTAL gpR OFFICE USE BASEMENT FIRST FIAOR(or Mobile Home) _ _. SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ OTHER(describe� SXISTI2P0 PROPOSED TOTAL . ........ ......... ......... ...._. .. ......... .... Area Totals **NEW HOME5 ONLY*" ESTIMATED SELLING PRICE$ #OF BEDROOMS COMMERClAL-NEWIADDITION AREA DESCRIPTION �ea Occupancy Group�s) �nstruction #of Additional Information in S uare Feet e Stories NEW BUILDING ADDITION COMMERCIAL -REMOVEL/TENANT IMPRUVEMENTS AREA DESCRIPTION Area Occupancy Group�s) Coastruction #of Additioaal Information in 8 uare Feet e Stories TOTAL BUILDING TENANT AREA ONLY PRWECT AREA ONLY Bulletin#100—January 1,2010 Page 2 of 4 k:\Handouts\Permit Application