20-102934 - APPLICATION4illkk6�
CITY 4F
Federal Way
PERMIT NUMBER
SIT$ ADDRESS
iU- �q
PROJECT VALIIATION s
$ GS, aQ0
TYPE OF PERMIT
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed description of umrk to
be included on this permit only
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + perrnitcenter@cityoffederalway.com
— — — TARGET DATE
SiIITE1LFNIT �
ZONING ASSESSOR'S T /PARCEL N
Z aS__ 5__ z 3 0- o z r 0'
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
AFm_ / AAMET-) (ormP e-,,TnlU
NAME
PROPERTY OWNER 5 �� +�] ��
MAILVIG ADDRESS
& PL
CITY I STATE I ZIP
CONTRACTOR
APPLICANT
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
PROJECT FINANCING
When value is $5,000 or more
(RCW 19.27-095)
NAME
MAILING ADDRESS
crrY
WA STATE CONTRACTOR'S LICENSE #
NAME ■
_-!5_e_ZQ
th i
CITY ^
NAME ma r�^
MAILING ADDRESS
CITY
NAME
MAILING ADDRESS, CITY, STATE, Zip
STATE ZIP
EXPIRATION DATE
A
STATE ZIP
STATE I ZIP
PRIMARY PHONE
E-MAII
"
wi�1 I - Long
PHONE
E-MAIL
FAX
VBI N
PRIMARY PHONE
3(co
E-MAIL
FAX
PRIMARY PHONE
#5Q YV1 w�
T MAIL
FAX
1N&INA51
OWNER -FINANCED
PHONE
f 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 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 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 clairN, which may be made by any person, including the undersigned, and flied against the city,
but only where such claim anises out of the reliance of the city, including its officers and employees, upon the accuracy of the
information supplied to the city as a papt of this application.
SIGNATURE; DATEZ f'1
PRINT NAME i/
Bulletin 9100 - February 19, 2020 Page 1 of 2 kAlHandouts\Permit Application
MECHANICAL PERMIT
.�....•"•'""••��••••
1� r^^'I+
GAS PIPE OUTLETS
AIR CONDITIONER
FIREPLACE INSERTS
HOODS,,_�,
BOILERS
_ FURNACES
HOT WATER TANKS loo)
COMPRESSORS
— GAS LOG SETS
REFRIGERATION SYST
PLUMBING PERMIT I?MUS OFPz;vM ING WORK
c
Indicate hom run o each e o fixture m be installed or rebmted as art o this ro'ect Do not include a ,es M remom.
BATHTUBS �mme/sneverOmeq L4V51x.ea swul TOILETS _ WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER Describe)
DRAINS _� SHOWERS _ VACUUM BREAKERS
DRINIHOSE BIBBS G FOUNTAWS SINKS pa�w.o/asap{ _ WATER HEATER 3 aa—,
HOSE BISUMPS WASHING MACHINES `E TOTAL PRTDRgg
GENERAL INFORMATION
CW'IfCAL A^tR8nN80N pROpERTyp
/VV
ERtE'MO/PRENOW UE6
G
WATERFUNVETOR
i AWG 4AVQ
LOT real U. 8Q I.)
71 Z 5
a. PURVEYOR
BBIBTINO BntE. BPRINeI.ER BYETEM]
❑ Yes g1 No
V.. OF EvsTnvG IMPROVIUMUT.
PROPOBBO EIRE BUPPREEBIOR i4ETBtlP
❑ Yes / NO
RESIDENTIAL —NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
......... .
FIRST FLOOR (or Mobile Home)
.............. ................. .........
SECOND FLOOR
___... .......................... ........... .........
COVERED ENTRY
_.. ..... ................... .
DECK_...
...... ........................... __..................................
GARAGE CARPORT El
�j50
.
.., .......................
OTHER (describe)
........ ............... .........
Area Totals
1909
.�.o>eo
I400
............... .......__..............
»»xEwsonves oxcF•^
ESTIMATED SELLING PRICE $ k OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
in
g �re Feet
ccupan
Ocy Groups)
Construction
Type
# of
Stories
pdAdditional]aformation
NEW BDD.aNG
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Aron in
8 uaro Feet
Occupancy Group(s)
Construction
Type
a of
Stories
Additional Information
TOTM, BUD.DmO
TRRAwr AREA ONLY
Pawater AREAONLV
Bulletin#100—February 19, 2020 Page 2 of2 k:\Hdouts\Pennit Application