20-103995-MF-BLDG PERMIT APPLICATION-01-18-2021-V1CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permiteenter4rrityoffederalway.com
TAR(wr DATE
SITE ADDRESS
SIIITRIUNIT R
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PROJECT VALUATION
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TYPE OF PERMIT
),BviLAiNG ,PLUMBING PLMECHANICAL ❑ I]EMOLrr[ON ❑ ENGINEERING 0 FIRE PR N-110N
NAME OF PROJECT
,I } WA
PROJECT DESCRIPTION
Detailed description o, f unrk to
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be included on this permit only
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PRIMARY PHONE
PROPERTY OWNER
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CITY
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CONTRACTOR
CITY STATE
ZIP
FAX
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WA STATE CONTRACTOR'S LICENSE ■
EXPIRATION DATE
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NAME
PRIMARY PHONE
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APPLICANT
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CITY
STATE
ZIP
FAX
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NAME
PRIMARY P8DRQQ8
PROJECT CONTACTff
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MA[1 is AD;
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(The indbAdual to receive and
respond to all correspondence
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CITY
STATE
ZIP
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conceming this application)
PROJECT FINANCING
NALIB
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L� OWNER -FINANCED
When value is ,$5,000 or more
MAHANG 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 4f the property owner. I csrt(fy that (o the best
of my knowledge, the Information submitted in support of this permit application is true and correct. I certM that I will comply with
all applicable City of Federal Way regulations pertaining to the work authorized by the Issuance of a permit. I undamtand that the
issuance of this permit does not remove the owner's responsibility for compliance with local, state, or federal lama regulating
construction or environmental laws.
I further agree to hold harmless the City of Federal Way as to any claim (including costa, expenses, and attorneys' fees incurred in
the investigation and defense of such claims. which may be made by any person, Including the undersigned, and filed against the city,
but only where such c! arises out of the reliance of the city, including Its officers and employees, upon the accuracy of the
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igpMation supplied to city�Pai"app"44"o-
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SIGNATURE. DATE
PRINT NAME:
Bulletin #100 — February 19. 2020 Page 1 of 2 k: WandoutslPerinit Application
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VAvmnuMECRA,,A=w.
MECHANICAL PERMIT
tMvaie Ame o each
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DISHWASHERS RAINWATER SYSTEMS U10t4Ms OTNER (Deec )
DRAINS SHOWERS VACUUM BREAKERS
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HOSE BIBBS SUMPS WABHING MACHIN85 TOTAL tR'NR89
GENERAL INFORMATION
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RESIDENTIAL -NEW OR ADDITION
AREA DBBCR ON Iha squmee [eat)
BBIBTINO
lmtom a,
TOTAL
ROR OTYICB IIBB
BASEMENT
MI FLOOR)or Mobile Noma
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT D
OTHER RIAW ibe)
Ama Totals
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ESTIMATED SELLING PRICE $ tl OF BEDROOMS
COMMERCIAL— NEW'/ADDITION
Ava•. DBBCRPTION
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COMMERCIAL — REMODEUTENANT IMPROVEMENTS
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