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20-104043 AMBOSELI- Building Permit Application 10-23-2020 -v1CITY Of 4k Federal Way PERMIT NUMBER PERMIT APPLICATION PERMIT CENTER + 33325 8th Avenge South + Federal Way, WA 98003-6325 253-835-2607 + FAX 253-835-2609 + permitcentet@,cityoffederalway.com — -- TARGET DATE + 1 to z o 2"-Z-) BITE ADDRESS !R�^� a.CTK 1/ � „E � f't� SUITE/UNIT # ¢ p;. �� CJ LJ iZ �- * 9 C) " 0 3 PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL # SDO-o TYPE OF PERMIT ;BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION NAME OF PROJECT PROJECT DESCRIPTION Detailed description of work to (�� ' C - �j� Q 3&5 � CJIr-1� _k-)(I �) 1 h gem • � g ��!!�p be included on this permit only t NAME PRIMARY P ONE PROPERTY OWNER MAILING"PRESS �® _ ! Y E E-MAIL 3 _ Pi�TiPs 8TANAME —� 9-b`o 3 PHONE MAILING ADDRESS E-MAIL CONTRACTOR CITY STATE ZIP FAX WA STATE CONTRACTOR'S L cmm # EXPIRATION DATE UBI # NAME T�S �UN 1�Y1 J M1 y,.n r7CY�- rl FC 2 PRIMARY PHONE a 1+2 APPLICANT M tt.TNG DRESS 12 a ot-11 Avi -S E-MAIL CITY STATE F V�+Q � — PPC- �S � 0 FAX r2 20 h iS PROJECT CONTACT NAME C�l.' S US C�1 f w PRIMARY PHONE (The individual to receive and respond to all correspondence MAILING ADDRi 100j Ci LQ M q: . concerning this application) CITY _ STATE ZIp FAX 1 Lo K C6L+'� ry �( r1 11 Z5 -e$ PROJECT FINANCING U &TJi-� 1714 ft-(f n- n 93. #t�)q-R 1L7Lq ❑ OWNER -FINANCED When value is $5,000 or mare (RCW 19.27.095) MAILING ADDRESS, CITY, STATE, zip PHONE _ 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 fled 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 city as a part of this application. Q,1Xj4".6AA1 SIGNATURE: DATE d 5 O1-b PRINT NAME:Cn 1 03 Bulletin #100 — February 19, 2020 Page l of 2 kAflandoutAPermit Application VALUE OF MECHANICAL WORK MECHANICAL PERMIT Indicate how many of each YLve. 2fftxture to be installed or relocated as part of this projecL Do not include existEqg fixtures to remain. AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe) AIR CONDITIONER FIREPLACE INSERTS HOODS (coma vil BOILERS FURNACES HOT WATER TANKS (t as) COMPRESSORS GAS LOG SETS REFRIGERATION SYST DUCTING GAS PIPING WOODSTOVES VALUE OF PLUMBING WORK PLUMBING PERMIT $ Indicate how many o each e o inure to be installed or relocated as art o this project. Do not include existin txtures to remain. BATHTUBS (orTub/showercomba) LAYS (]A—dsink,) TOILETS WATER PIPING DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe) DRAINS SHOWERS VACUUM BREAKERS DRINKING FOUNTAINS SINKS Ntchen/utility) WATER HEATERS (Eiecu-) HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES GENERAL INFORMATION CRITICAL AREAS ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EMSTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM? c Yes ❑ No ©"Yes © No RESIDENTIAL -NEW OR ADDITION AREA DESCRIPTION (in square feet) EXISTING PROPOSED TOTAL FOR OFFICE USE BASEMENT FIRST FLOOR (or Mobile Home) SECOND FLOOR COVERED ENTRY DECK GARAGE ❑ CARPORT ❑ ......................................................................................................... OTHER )describe) R %00� Area Totals EXi3TItYG PROPOSED TOTAL **NEW HOMES ONLY** ESTIMATED SELLING PRICE $ # OF BEDROOMS COMMERCIAL - NEW/ADDITION AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information NEW BUILDING ADDITION COMMERCIAL - REMODEL/TENANT IMPROVEMENTS AREA DESCRIPTION Area in Square Feet Occupancy Group(s) Construction a # of Stories Additional Information TOTAL BUILDING TENANT AREA ONLY PROJECT AREA ONLY Bulletin #100 -February 19, 2020 Page 2 of 2 kAHandoutsTermit Application