20-104331-Building Permit Application-CITY 4F
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenterGcityoffederalway.com
TARGET DATE
SITE ADDRESS
3 WC/71-1
SUITE/UNIT #
I 1 ra
PROJECT VALUATION
ZONING
ARf/ SSESSOR'S TAX/PARCEL �l L, ` %�
D
- /3 0 c-0
i 42 — [o
TYPE OF PERMIT
BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOI rrION ❑ ENGINFiFiRING ❑ FIRE PREVENTION
NAME OF PROJECT��
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME
PRIMARY PRONE
PROPERTY OWNER
MAILI RESS
24 00
Is -MAIL
W
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CITY AT);
2IP
AME^ un` . � -,
`j�J
PRONE �Z I � C✓I Ll
MAILING ADDRESS
Lti �'
CONTRACTOR
CITY `
1 -
STATE
�
ZIPje 'F
0U ,5
FAX
WA STATE CONTRACTOR'S LICEN E #
��
EXPIRATION DATE
t
UBI #
i�31
NAME ^ , j �
PRIMARY qZ5_ NE
4- /�
L'q
MAILING ADDRESS
r "k �r
E-MAIL
ln.ie-v4
APPLICANT
CITY
STATE
yV„V ,iS_
ZIP W6W ,
W
FAX_
NAME �� +
�✓�
PRIMARY PHONE
� 3 � �!
�1
PROJECT CONTACT
71
MAILING ADDRESS r 4
E-MAIL
(The individual to receive and
respond to all correspondencet?
CI _ / ( W s1�
[�`-'.L1WO . I—
ZIP ,q i -
c 1 7
FAX
concerning this application)
PROJECT FINANCING
N AME
WNER-FINANCED
When value is $5,000 or more
fRCW 19.27.095J
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 FederaI 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 Iaws regulating
construction or environmental laws.
I further agree to hold harmless the City of FederaI 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 f led 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 art of this application.
SIGNATURE: DATE''
�^
r
PRINT NAME: Y�
or —I
Bulletin If 100 --- February 19, 2020 Page 1 of 2 k:lHandoutslPermit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT
AIR HANDLING UNITS
_ AIR CONDITIONER
_ BOILERS
_ COMPRESSORS
DUCTING
PLUMBING PERMIT
_ FANS
FIREPLACE INSERTS
FURNACES
_ GAS LOG SETS
GAS PIPING
GAS PIPE OUTLETS
HOODS (commerrioi)
HOT WATER TANKS Icoo7
_ REFRIGERATION SYST
WOODSTOVES
OTHER (Describe)
VALUE OF PLUMBING WORK
Indicate how man o each t e o
Ixture to be installed or relocated as
art o this ro'ect. Do not include
existin tares to remain.
BATHTUBS Hoene/snoaeeomsol
LAYS Ixooa smgs�
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
O'fIiCR (Describe)
_ DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS ptimeeo)uenuy�
WATER IIEATERS (etem,;o�
HOSE BIBBS
SUMPS
WASFIING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREA8 ON PAOPERTY2
WATER PURVEYOR
SEWER PU)RVEYOR
VALUE OF EXISTING IMPROVEMENT6
-
�e-��%�/rr✓C/y-�
�-!�'uf�l�f/��Vi/✓�
� 7i/ 5�13A2>Z✓ (y
EXISTING/PREVIOUS USE
Pl�l� �
TAT STZE lIv Sgvaxe Feetl
� .3 3/
EXISTING FIRE SPRINKLER SYSTEM?
❑ Yes �No
PROPOSED FIRE SUPPRESSION SYSTEM?
❑Yes o�'o
Bulletin #100—Pebmary 19, 2020 Page 2 of2 k:\Handouts\Permit Application