20-104271-Building Permit Application-11-05-2020-V1PERMIT NUMBER ! - o
PERMIT APPLICATION
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
to L 2 J --S ! TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VALUATION
�( O
ZONING
ASSESSOR'STyA%/PARCEL #
E'1 ( !' - L) 6 C�
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
�� e L
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
v) Avx C-1 U1 'u
PRIMARY PHONE
MAILING ADDRESS
2 22 Zq kv c S VJ
E-MAIL
rtn� env ti.L'CQ 91J
PROPERTY OWNER
CITY
4ZA
STATE
ZIP
z o
NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONT OR'S LICENSE #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
MAILING ADDRESS
"Dv
E-MAIL
APPLICANT
CITY
STATE
ZIP
FAX
PROJECT CONTACT
NAME
�� e � "�
PRIMARY cPHONE b
2p C.54 8 `1
MAILING ADDRESS
DV C
E-MAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME JA�t r
OWNER -FINANCED
When value is $S, 000 or more
(RCW I9.27.095)
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 authorised 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 filed 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 oftthlis application.
SIGNATURE: kG C 9- d� w" 1'%f ru DATE
PRINT NAME 'ce ` c
Bulletin # 100 - February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT
Indicate how many of each I&P
AIR HANDLING UNI
AIR CONDITIODIE
PLUMBING PERMIT
Indicate how many o ch t
BATHTUBS (or /shower combo)
DISHWAShiERS
E[RINKING FOUNTAINS
HOSE BIBBS
NIA
to be installed or relocated as
FANS
FIREPLACE INSERTS
FURNACES _
GAS LOG SETS _
GAS PIPING
A]
to be installed or relocated as
LAVS (Hand Sinks)
RAINWATER SYSTEMS _
SHOWERS
SINKS (Kitchen/utaity) /
SUMPS ^
VALUE OF MECHANICAL WORK
$
this ro' Do not include existi yes to remain.
GAS P OUTLETS OTHER (Describe)
H S (commercial)
OT WATER TANKS (G�1
REFRIGERATION SYST
WOODSTOVES
-'VALUE OF PLUMBING WORK
l this ect. Do not include e)dsting flxtures to remain.
TS WATER PIPING
RINALS OTHER (Describe)
VACUUM BREAKERS
WATER HEATERS (Ertr )
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
L,Pfte-: t'l'P' u�� 1E*j t-s AIT-YL
SEWER PURVEYOR
f n Z+11 `J'v
VALUE OF EXISTING IMPROVEMENTS
y
J
L1.i9—M Y �'.. 1` D j+d Vl
s/<� /Q/y
J J Cor7"=�v J" s • - p `
l y
$ 7 ( n V
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
�e
❑ YesX No
ElYes J, No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
'
COVERED ENTRY
b
90� c
DECK..
I
GARAGE $' CARPORT ❑
%
OTHER (describe)
Area Tota ZsSTING
ZLf 33
PROPOSED
k
TOTAL
2 C13
**MEW HOMES ONLY**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
FOR OFFICE USE
COMMERCIAL - NEW/ADDITION
AREA DESCRIPTION
Area in
S uare et
Occu anc Grou s
p y p()
Construction
# of
Additional Information
a
Stories
NEW BUILDING
ADDITION
COMMERCIAL - EMODEL/TENANT IMPROVEMENTS
AREA DESCRI ON
Area In
Square Feet
1r
Occupancy Groupo)
Construction
# of
Additional Information
Ty pe
Stories
TOTAL BUILDI
p
TENANT AREA ONLY
s' {r
PROJECT AREA ONLY
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\HandoutsTermit Application