20-104187-Building Permit Application-10-28-2020-V1CITY OF PERMIT APPLICATION
Federal Way PERMIT CENTER + 33325 811� Avenue South + Federal Way, WA 98003-6325
253-835-2507 + FAX 253-835-2509 + permitcenterrr.:citvofFederahva%•.crmI
PERMIT NUMBER _
— — TARGET DATE
SITE ADDRESS �y
� r 1 L. SUITEILT3iIT e
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL X
$ 10�
TYPE OF PERMIT BUILDING PLUMBING ECIIANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
PROJECT DESCRIPTION
Detailed desr-ription of uxmrk to
be included on this permit only
PROPERTY OWNER
CONTRACTOR
APPLICANT
PROJECT CONTACT
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NAME A
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MAILING ADDRESS
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MAILING ADDRESS
wA STATE CONTRI
MAILING ADDRESS
LICENSE N
7PRIMIARY
S.
STATE 'CI rr yy
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STATE
ZIP
EXPIRATION DATE
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STATE
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ZIP
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E-MAIL
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FAX
DHI •
PRIMARY PHONE
E-MAIL
LL
p
co
FAX
PRIMARY PHONE
(The indiuidual to receive and MAILING ADDRESS E-MAIL
respond to ail correspondence 0S�Ar 7ji� V 1�H 7 ❑ Mti • C
concerning this application) TY STATE ZIP
FAX
PROJECT FINANCING HA—
R'nti� . OWNER -FINANCED
Ulhen value is $5,000 or more MAILING ADDRESS, CITY, STATE, ZIP �y� �
fRCLi' !9.?7.[145I 1 � T L ����T`- � ` � tl NE
I certify under penalty of perjury that I am the property owner or authorized agent of the property awner. 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 Iocal, state, or federal taws 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
PRINT NAME: C.--. ❑ _v .���
Btllictin #, l00 - February 19, 2020 Paac I of -I k:Jiandouts\Permit Application
MECHANICAL PERMIT
WORK
_GNITB
z FANS
GAS PIPE OUTLETS OTHER (Describe)—b e)-
AIR CONDITIONER
FIREPLACE INSERTS
_
HOODS Icemmnaal
= BOILERS
— FURNACES
— HOT WATER TANKS Ic..I
COMPRESSORS
GAS LOG SETS
— REFRIGERATION SYST
DUCTING
GAS PIPING
WOODSTOVF_C
PLUMBING PERMIT VALUEOFPLNMBINGWORK
$ 2S
Indicate how man o each o afore m be i,lamlted ar remmfed as o this ro'ect. 1M rwI include exist' rss m remain.
_L BATHTUBS b. r..elsl�w�.mmml 2 LAVE Mina siaml 1 TOILETS i WATER PIPING
DISHWASHERS RAINWATER SYSTEMS — URINALS -- OTHER(Describe)
_3 DRAINS SHOWERS VACUUM BREAKERS
i DRINKING FOUNTAINS L SINKS Ilame ,a,, WATER HEATERS laumq
HOSEBIBBS SUMPS L WASHING MACHINES TOTAL PDITURES
GENERAL INFORMATION
CRn[vAL N2.ta oa rROeeRIYx
a(A
EYial'rao/eseVloOa veE
-k, rs l O�� er `
WATe1 PURVEYoa
Pr�'we�w'
LO'1'9v5L ltn ago,n Faetl
I C .0
aeWea paRVeroa
1cu?r�wa.�
aRaMGrnle 9PRlalaeR a44I'¢Nx
o Yes o
v.V.ve or LerBrAEmrROVermar8
s 2F7�
PROPOaeo rma evPPRP,9aton 8Y81'EM,
❑ Yes 4c7Vo
RESIDENTIAL. -NEW OR ADDITION
AREA DESCRIPTION (in Square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
......__
FIRST FLOOR Ior Mabile Nomel
C)
SECOND FLOOR
COVERED ENTRY
DECK
. _. _____......
GARAGE I. CARPORT "I
OTHER (descre c)
Area Totals
run-
'?_ tD
—ma.
56'2
3 cS
„xslFeoFrea
oNzr•
ESTIMATED SELLING PRICE $
k OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area I.
-_A_ uare Feet_
Occupancy Groups )
Construction
e
0 of
Stories
Additional Information
NEW B06DN10
AmuTION
COMMERCIAL—REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area In
Square Feet
Oocupancy Gmup(rl
Coaatmetion
a of
Star es
Additional Information
TOTAL BtiD.DBm
T..T AF., GnLY
PRO.m.CT AREA oNLT
Bulletin M100-Febmary 19, 2020 Paget oft k:\HandoutsTermit Application