20-102858-Building Permit Application-N�- PERMIT APPLICATION
CITY GF =�
PERMIT CENTER + 33325 8� Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcente dcityoffederalway.com
PERMIT Numssp- _ _
'TARGET DATE
SITE ADDRESS
SUITEMNIT 8
30913 6th Lane SW, Federal Way, WA 98023
Lot # 14
PROJECT VALUATION
ZONING
ASSESSOR'S TAXIPARCEL #
$ 165,900.00
5 5 5 7 9 0 _ 0 1 4 0
TYPE OF PERMIT
[S BUILDING X) PLUMBING lK MECHANICAI, ❑ DEMOLITION ❑ ENGINEERING l6 FIRE PREVENTION
NAME OF PROJECT
Mirror Lake Highland
Build a single famil residence
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
Mirror Lake Highland LLC
PRIMARY PHONE
253-709-8747
PROPERTY OWNER
MAILING ADDRESS
30929 37th PL SW
E-MAIL
bill@thenexusstudio
°fFederal Way
STATE
WA
ZIP 8023
Cam
NAME
The Nexus Studio Inc.
PRONE
same
MA=ING ADDRESS
(same as above)
E-MAII.
same
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE N
NEXUSS1839M6
EXPIRATION DATE
7 24 122
USI N
NAME
PRndARY PHONE
The Nexus Studio Inc.
same
RAILING ADDRESS
(same as above)
E-MAIL
same
APPLICANT
CITY
STATE
ZIP
FAX
NAME
PRIMARY PHONE
PROJECT CONTACT
Bill McCaffrey
same
MAILING ADDRESS
same as above
E-MAIL
same
(The individual to receive and
respond to all correspondence
CITY 6-7
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
�r,
) OWNER -FINANCED
Mien value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
I cert(fy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fij that to the best
of my knowledge, the ir{formatlon submitted in support of this permit application is true and correct. I certVy 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 Iaws.
I further agree to hold harmless the City of Federal Way as to any claim /including costs, expenses, and attorneys' fees incurred to
the investigation and defense of such claim), which may be made by any person, including the undersigned, and flied against the city,
but only where such claim arises out of the reliance of the city, including its off4cers and employees, upon the accuracy of the
information supplied to the city as apart of this applie tion.
SIGNATURE:�y DATE
PRINT NAME: W I LL, ( 1-
Bulletin 4 100 - February 19, 2020 Page 1 of 2 k:1E IandoutslPermit Application
VALUE OF MECHAMc,AL WORK
MECHANICAL PERMIT $ 4000.00
Indicate how many of each type of flxture to be installed or relocated as part of this project. Do not include existinqjbctures to remain.
AIR HANDLING UNITS 3 FANS 3 GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commcrciat) Gast-, Stove
BOILERS FURNACES HOT WATER TANKS pas) Heater -
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING 1 GAS PIPING WOODSTOVES
VALUE OF PLUibMING WORK
PLUMBING PERMIT
$ 5000.00
Indicate how many of each type offixture
to be installed or relocated as part of this project. Do not include existing res to remain.
BATHTUBS (or Tub/Shawcr Combo)
3
LAVS (Hand Sinks►
9 TOILETS
�_ WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
�—
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
�_
SINKS (ratchen/Utiiity)
WATER HEATERS (Electric(
13
HOSE BIBBS
SUMPS
,_ WASHING MACHINES
TOTAL FIRTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PUT043MR
VALUE OF RJ[IiB7ilYli ffiPROV83fzm
NA
Lakehaven
. Lakehaven
NA
$
wasmG/PREVIOUS USE
LOT SIZE (Ia square Feet)
EIOSTING FIRE SPRI MER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
Vacant Land
2480
❑ Yes X No
X ❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
............................................................................................................................
'BASEMENT
_ „
FIRST FLOOR (or Mobile Home)
853
............................................................................................................................
s eOND FLOOR
441
COVERED ENTRY
126
............................................................................................................................
DECK
1 O8'.
GARAGE ❑ CARPORT ❑
............................................................................................................................
OTHER (describe)
Area Totals
a
15 8AL
raw -trots
orwY►* .' .
4252000
3
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL— NEW/ADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Stories
Additional Information
Square Feet
A8W BOII,DiNG
ADDITION
COMMERCIAL — REMODEUTENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Stories
Additional Information
Square Feet
TOTAL BUtLDINQ
om
TENANT AREA ONLY
)PR0�1�CT�AREA ONLY -
Bulletin #100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application