21-101576-SF Permit Application 4-26-21 V1PERMIT APPLICATIONCITY OF
PERMIT CENTER + 33325 8th Avenue South + Federal Way, WA 98003-6325
Federal Way 253-835-2607 + FAX 253-835-2609 + permitcente ej)cityoffederalway.com
PERMIT NUMBER _ O L ( _ 5 TARGET DATE 5 1
SITE ADDRESS
SUITEIUNIT i
Yf -��'S� t �� e a� Wa WA- T?D 23
PROJECT VALUATION
TONING
ASS 'S TAXIPARCEL ik
$ 30OIl r()D—
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
i n r ci e c K
PROJECT DESCRIPTION
—
Detailed description of work to
be included on this permit only
NAME
C 6
PRIMARY PHONE
153 v)oV-vAu 7
PROPERTY OWNER
MAILING ADDRESS
E-HAIL
C,J, TY� a t^G � � �
f1f"��C.-
srera
vJAV
ZIP
L q%D23
NAME
Cai5C/VV1'A, &-H0tq
PHONE
KA9,ING ADDRESS
-D b S ti 3L'y
E-MAIL e oy -2
CONTRACTOR
CITY
STATE
vV►4
�IP� D��
(JI
FAX
a urn
WA STATE CONTRACTOR'S LICBNSE N
EXPIRATION DATE
UBI N
i
NAME
cLs C L
PRIMARY PHONE
as m t, a e4
APPLICANT
MAILING S 73 to , 7� r.
U T
E-MAIL
M71X i�u Get`J�
CIi']y� r
ii�J_VI�'
'"ATE
ZIP
FAX
NAMByr a s vntr`-- o e
PI21lMAItY PHONE
56 a
PROJECT CONTACT
l/�'
V
0 & 1,0
MAILING ADDRESS
E-MAIL
racere-3Da
(The individual to receive and
respond to all correspondence
0"'I
e4 �r�
b
n�'�E
u�'
��D f
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER FINANCED
When value is $5,000 or more
MAILING ADDRESS, CITY, STATE, 74P
PHONE
(RCW 19.27.095)
I certify under penalty ofperjury that I am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the irgforrnation 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 doeWnot
't1L� be is nsibility for compliance with local, state, or federal laws regulating
construction or environmenI
further agree to hN eder Way as arty claim (including costs, expenses, and attorneys'fees incurred in
the investigation a defensJ, whi uey be by any person, including the undera{gnecl, andfiled against the city,
but only where ch claim reliance the city, including its officers and employees, capon Lire accuracy of the
information s plied to the cf this app tion.
-7
SIGNATUR&: DATE
PRINT NAME:
MEE
Bulletin ##100 —February 19, 2020 Page 1 of 2 k:lHandoutslPermit Application
2-1-1oI�:,7to-5fi
12-3
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
AIR HANDLING UNITS
FANS
GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER
FIREPLACE INSERTS
HOODS (c..m w
BOILERS
FURNACES
HOT WATER TANKS (G—(
_ COMPRESSORS
GAS LOG SETS
REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$
Indicate how many of each type of fixture
to be installed or relocated as part of this project. Do not include e;dstirkq fixtures to remain.
_ BATHTUBS (.Tub/s combo)
LAVS (Hm slurp
_ TOILETS WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS URINALS OTHER (Describe)
_ DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS (ri m/vmtyj
WATER HEATERS (EI« )
HOSE BIBBS
SUMPS
WASHING MACHINES TOTAL FIETURE$
GENERAL INFORMATION
CRITICAL ARRAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF HIIBTIIYG QAPROVEMFNTS
FASTING/PREVIOUS USE
LOT SIZE
it. Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED F SUPPRESSION SYSTEM?
❑ 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
C
GARAGE ❑ CARPORT ❑
- ----._—__—
OTHER (describe)
Area Totals
»»Ivewsaws oAzr»
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group($)
Construction
• of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area is
Square Feet
Occupancy Group(a)
Construction
N of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 —February 19, 2020 Page 2 of 2 k:\Handouts\Petmit Application