20-102792-Building Permit Application-07-16-2020-V1CITY OF
PERMIT APPLICATION
PERMIT CENTER + 33325 Sth Ave-nue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 permltccntcri�,)cityoffederala,com
PF,RMIT NumBER - TARGET DAT. e -- ---a ?V-.0
SITE ADDRMS SUITE/UNIT #
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PROJECT VALUATION ZONING AS E SSOR" S TAXI PARCEL #
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TYPE OF PERMIT '�(BUILDING ❑ PLUMBING ❑ MECHANICAL LAICAL ❑ DEMOL1' ON ❑ ENGINEERING ❑ [IRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
tat -led de scr�ptin of u rk to
be included on u s permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
he indftAdual to receive and
respond to all correspondence
ny this application)
PROJECT FINANCING
When vaFae LS $5, 000 or more
(RCW 2 9.27. 095)
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I certify under penalty of perjury that I the property} owner or authorized argent of the p mperty owner. I certify that to the best
of my knowledge, the infor a do n submiMd Its suppo rt of th is perm i t appi i ratio n is true and co rmct. I Bert ify that I wi It ciap ly with
a i i app licab Ie City Df Pederat Way regulatians pertaining to the work authorized by the ftsuartce of a permit. f understand that the
issuance of this permit does not re tin c oe the owner's responsibility for compliance with form, ,state, or federal laws regulating
construe don or environmental laws.
I further agree to ho f d harmless the City of Federal Way as to any claim (including costs, expenses, and a ttorne [ys' fees incurred in
the investigation and defense of such claim), which may be madc by any person, including the undersigned, and fi led against the city,
but only where such claim arises out of the rei iaace of the cfty,, inc I u d i ng its offs ee rs and Employees, upon the accuracy of the
Informations a 'ty as a part of this arppiic ion.
SIGNATURE; IL DATE
PRINT NAME:
Bulletin # 100 — Febraary 19, 202 0 Page 1 of 2 k: an do uts\P erm�t Application
VAL UR OF MEC i 7VICAL WO R
MECHANICAL PERMIT
Indicate hour man
AIR HANDLINQ UNIT
AIR CONDITIONER
BOILERS
COMPRESSORS
DUCTING
e offixture to be installed or relocated ms par,
FANS
FIREPLACE INSEFATS
FURNACES
ETSETS
AS LOG i 4
GAS PIPING
1 $
of is project. Do not include
GAS PIPE OUTLETS —
HOODS (co mcr-cia]l
HOT WATER TANKS
REFRIGEPATION SYST
WOOD TOTE
L-3drig ujures to rea_
GTH ER (Describe)
VALUE OF PL UMBL! TC WORK
PLUMBING PERMIT Is
Ind icate how many of each type offixture to be Mailed or relocated as part of th is projer-t. Da not include exLs ting fixtures to remg in.
BATHTUBS (nr Tub/ 9h vrr C„ibo j LAVS Wand si r ke) TOILETS WATERPIPING
DISHWASHERS RAINWATER SYSTEM URINALS OTHER (Describe)
MAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS � SINKS (Kitchen {utLhrA _ —WATER HEATERS Wectxic) _
HOSE BIBBS SUMPSWASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRMCAL AREAS ON PROPERTY? WATER PURVEYOR SEVER PURVEYOR VALUE OF EMS TING IMPROVEMENTS
=STING I PREVIOUS USE WT SIZE 11a Square Pact] E XISTINO FMR SPRINKLER SYSTEM? PROPOSED FIRZ SUPPRE4MON SYSTEM?
Li e)4,No f-i Yes )<No
REIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet EXI STING
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FL O R
COVERED ENTRY
DECK
PROPOSED
GARAGE ❑ CARPORT v E +�1 56f�- 34�szr*
OTHER (describe)
Area Totals
ESTIMATED ELLIN PRICE ,
EJULT1
Is I IV) N G
**NEW HOMES ONLY
P IRt op"r
@Ertl
X-3 � f
# OF BEDROOMS
TOTAL
an
FOR OFFICE USE
Bulletin 9l 00 — February 19, 2020 Page 2 of 2 kAHandcuts\Permit Application