20-102974-Building Permit Application - 07-27-2020-V1C t T Y OI ,.
Federal Way
PERMIT NUMBER _
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + perrnitcentertoicityoffederalway.com
TARGET DATE e-
SITE ADDRESS, / / `��� J ^oM 3
SUITE/U NIT
PROJECT VVALLUATION
ZONING
ASSESSOR'S TAX/PARCEL N 41 4 �% /
G� — O
TYPE OF PERMIT
KBUILDING ElPLUMBING ❑ MECHANICAL ❑DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
✓�L CG�d �� "' _ l`� `
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
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NAME
PRIMARY PHONE
Zs3. z2 z - 3�8�
PROPERTY OWNER
MAILING ADDRESS
E-MAIL
y [�
STAT114
NAME � OI ' �
Cam- (�C/rL
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
—�
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE N
EXPIRATION DATE
UBI A
NAM
,�j4�
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
CITY
STATE
ZIP
FAX
NAM
PRIMARY PHONE
PROJECT CONTACT
/fir% !%`mil
MAILING ADDRESS
E MALL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
WNER-FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
J
I 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 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 ' as apart of this application.
SIGNATURE: DATE
PRINT NAME:
Bulletin #100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type offbcture to be installed or relocated as part of this project. Do not include existin 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
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each type offikture
to be installed or relocated as
part of this project. Do not include existirkqfwtures to remain.
BATHTUBS (or Tub/shower Combo)
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (i(itchen/utility)
WATER HEATERS (Electric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CR,IITIICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
$ Zr CZVo
EXISTING/PREVIOUS USE
A?e5mAwA1<2v
LOT SIZE (In Square Feet)
EXISTINCr FIRE SPRINKLER SYSTEM?
❑ Yes)rNo
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes IvNo
RESIDENTIAL. - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
.BASEMENT-
..................................................................
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
........................................ .
CG`JERED ENTRY
............................................................. _................................................. _ _ .
DECK ,
.................................................................
GARAGE ❑ CARPORT ❑
...................................................... ........... ......... ....... I.............
............................................................................... ..........
Area Totals
EXISTING
PROPOSED
TOTAL
***NEW HOMES
ONLTr*T .`
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
S uare Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Iaformatioa�
NEW BUILDINl3
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy
P y Group(s) PIsl
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
I TENANT AREA ONLY
L::PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application