21-100081-Building Permit Applicaton -05-04-2021-V1PERMIT APPLICATION
PERMIT NUMBER !J ( , -7> <=> <.=3 i
PERMIT CENTER + 33325 811 Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 +
TARGET DATE • A5 1 �'C� 2
SITE ADDRESS
SUITFJUNIT #
PROJECT VALUATION
$��o�`l
ZONING V el
4d�5�
ASSESSOR'S TAXIPARCEL#
C_ 4 A c - 1
TYPE OF PERMIT
ld BUILDING
PLUMBINGE:l MECHANICALE:l DEMOLITION 11 ENGINEERING FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
F✓
Detailed description of work to
be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAKING ADDRESS
E-MAIL
CITY
F-I al V""i�%
STATE
IIP�`�''�
NAME / Rh
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
LP
FAX
WA STATE CONTRACTOR'S LICENSE#
EXPIRATION DATE
UNI#
NAME y _
PRIMARYPHONE
MAILING ADDRESS
►3 �4+'
EMAIL
APPLICANT
CITY
Cie,-- lera1 0A.
STATE
1 A
ZIP
FAX
NAM
PRIMARY PHONE
PROJECT CONTACT
Z
52 -^ -:3 1 4
MAILING ADDRESS
EMAIL
(The individual to receive and
respond to all correspondence
CITY
STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 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 of this
application.
SIGNATURE: DATE G:214 '�Z (
PRINT NAME:
Bulletin #100 —February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
f-4 Ais,
is SO
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include exi ing fixtures to remain.
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS
BOILERS
FURNACES
HOT WATER TANKS (Gu)
COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
VALUE DF PLUMBING WORK
PLUMBING PERMIT
r�.j
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include is exing fixtures to remain.
BATHTUBS
LAVS tH, es,k:l
TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS Ir I,rl
WATER HEATERS (EW.W.)
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREASON
WATER PURVEYOR
SEWER PURVEYOR
OF EXISTING IMPROVEMENTS
iPROPERTY?
r 7
�k i�T
r^x i
VALUE
EXISTINGIPREVIOUS USE
LOT SIZE pn Sqw F.et)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes* No
❑ Yes ,( No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
fcx5
r, i 3i i
FIRST FLOOR (or Mobile Home)
SECOND FLOOR
COVERED ENTRY
vJr� ►
41 . S .
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
��—
Area Totals
E—TING
PROPOSED
TOTAL
1 9 s L
F.
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION t. A
AREA DESCRIPTION
Area in
Feet
Occupancy Group(s)
Construction
Type
Stones
Additional Information
--Square
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS /A
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
Stones
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY