21-101308-SF-PERMITAPPLICATION-04-02-2021.V1�
CITY Of -
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 80, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter(ci:crtyoffederaiway.com
_ TARGET DATE O q 12-Z) Zo Z 1
6ITE "DRESS �
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SUITE/UNIT A
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL i
1 Z S 3_ o O Z a
,000^ o0
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TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT,
Del-1L-
UnIT"
PROJECT DESCRIPTION
Detailed description of "rk to
be included on this permit only
NAM''E��7 �J
PRIMARY
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MAILING ADDRE7SSSQO c V J
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PROPERTY OWNER
CITY
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ZIP
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NAME
PHONE
MAILING ADDRESS
E-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE B
EXPIRATION DATE
UBI B
NAME��
PR�IyMARY.,�RY PHONE o
APPLICANT
MAILING ADDRESS
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E-MAIL
STATE
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IP
FAX
,
NAME
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PRIMARY PHONE
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PROJECT CONTACT
(The individual to receive and
MAILING ADDRESS
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respond to all correspondence
concerning this application)
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IP
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PROJECT FINANCING
NAME �� !
OWNER -FINANCED
When value is $5,000 or more
(RCIV 19.27.095)
MAILING ADDRESS, CIIF STA , ZIP
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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
does not remove the owner's responsibility for compliance with local, state, or federal laws regulating
issuance of this permit
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. /
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DATE
SIGNATUF IF
PRINT NAME: �Iac 13E�i6v
Bulletin # 100 — February 19, 2020
Paget oft kAl-landoutsTermit Applicatio
VALUE OF MECHANICAL IVORK
MECHANICAL PERMIT Is
Indicate how man o each t e o fixture to be installed or relocated as art o this project. Do not include existinginures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDMONER FIREPLACE INSERTS HOODS Ic�mmrrne )
BOILERS FURNACES HOT WATER TANKS (Ga,)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT Is -Indicate how man o each e o Lxture to be installed or relocated as art o this project. Do not include existingm res to remain.
BAT14TUBS (or Toh/Shower G�mho) LAVS (11—d Sink,) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (Kitchen/Utility) WATER HEATERS (Electric)
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)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL — NE`V OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
. .......... ........................................... _...................................... ............. I .............. ...
_ .............................................. ........... ...................................................... ...
BASEMENT
FIRST FLOOR (or Mobile Home)
...............................................................................................................................
SECOND FLOOR
............................................................ _.......... .................... _.............................
COVERED ENTRY
...........................................................................................................................
DECK
t 21!zS
tt++
'�1�'�
.Z-1 Z
........_..............................................................................................................
GARAGE O CARPORT O
............................... ............................................................. _...... ......................
OTHER (describe)
Area Totals
EXISTING
Z
PROPOSED
TOTAL
2 1 Z,
**NEW HOMES
ONLY**
ESTIMATED SELLING PRICE $
1 # OF BEDROOMS
COMMERCIAL - NEw/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL - REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 — February 19, 2020 Page 2 of 2 kAHandoutslPcrmit Application