21-100038-SF-Building Permit Application-01-12-2021-V1I PERMIT' APPLICATION
CITY of
PERICT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcenter(ucityoliederalway.com
PERIIfIT NUhMZR _ /`�5`';o
— -- TAIta>s'rDATE
WTBADDRESS
SUITEMNIT 4
Wo sw 339f 5 Fez4f,,1 W,�k , Wh 990a3
PROJECT VALUATION
ZONING
ASSESSOR'S TAXIPARCEL I
$ IT 975, 60
reside �,a1
.9-
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
D
e,jvOl�'I5&� case
Detailed description of tcaork to
13,41 ne � ' S - f
be included on this permit only
NAME
7e � Cqrer 1�/uG n f�
PRIMARY PHONE
�5-3, 35�) 85Y7
PROPERTY OWNER
„AILING „D IZ
'35,,l 3 3%t4 j
E-KA&
f
(%O
lln rrlal
CITY
fco"W
rrA-m ZIP
L:'Rr '. ,2 31
NAME r?Mora1LC
PRONE�<X 73� �a�M
MAII.iAa AnnR>�ae P. Rao
EMAIL)& , e
CONTRACTOR
COPY
STATE
ZiP
FAX
WA STATE CONTRACTOR'S LICENSE i
t Maps. 7Q11 &F
EXPIRATION DATE
nc g
USI I
-633-4-/7/
NAME r�s �� f�
PRDffA" PHONE
NMILINOADDREss ft oZ�� ST G'
APPLICANT
CITY
STATE
�1A
ZIP
7
fr.T`
FAX
PROJECT CONTACTt
PHONERAM PRULAMY
HAILING Annt�sssC� o p
a /�/ 4fy'- e
it -WAR
R
(Tice individual to receive and
respond to all correspondence
C
STATE
ZIP
if"
concerning this application)
PROJECT FINANCING
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
iRCW 19.27.0951
I certgy under penalty of perjury that I am the property owner or authorised agent of the property owner. I certify that to the beat
of my knowledge, the Wormadon submitted in support of this permit application is true and correct. I cert{fy 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 lards regulating
contraction or environmental laws.
[further agree to hold harmless the City of Fedemi Way as to any claim (including costs, expenses, and attorneys' fees inrwr+ed in
the insestigation and defense of such cla(m), which may be evade by any person, including the undersigned, and jllad against the city,
but only where such claim arises out of the reliance of the city, including Its ojrieers and employees, upon the accuracy of the
information supplied to the city as a part of this application.
)
SIGNATURE- DATE
PRINT NAME:
(`--4
Bulletin #100 — February 19, 2020 Page 1 of 2 kAHandoutslPermit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
_ AIR CONDITIONER
FIREPLACE INSERTS
HOODS (com w)
BOILERS
FURNACES
HOT WATER TANKS (o. )
_ COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOO➢STOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate howl many of each Wpe offuture
to be installed or relocated w part of this Project Do wt include e=tinq fkatres to remaim
_ BATHTUBS (,1 b/shower W]
LAVS aimda ]
TOILETS __ WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS _ OTHER(Deacribe)
_ DRAINS
SHOWERS
_ VACUUM BRRARRRS
DRINKING FOUNTAINS
SINKS (K Iuwi A
WATER HEATERS (ems
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS OR PROMRTY?
WATER PURV6VOR
86WER PIntVEYOR
VALUE OF 6EEMM namoVE�NTB
mm"ING/FREY70118 vas
LOT SIZE pn Sq. P«tl
EEIarING mm aPRINiILER ararE ?
PROPOSED FIRE SUPPRESSION sysT6w?
❑ Yes ❑ No
❑ Yea o No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
&%[STING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (descnbe)
Area Totals
j 4"5
.2 '6
R
"NEW HOMES ONLV-
ESTIMATED SELLING PRICE $
N OF BEDROOMS
COMMERCLAL — NEVADDITION
AREA DESCRIPTION
Area
Feet
Occupancy Group(s)
Construction TypeSt
roles
Additional Information
NEW BUI DING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
0 of
Stories
Additional Information
TOTAL Bumar IO
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 k:Uiandouts\Petmit Application