21-101209-Building Permit Application-3-30-2021-V1PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 8tb Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentef@,cityoffederalway.com
TARGET DATE
SITE ADDRESS
i
SUITE/UNIT #
PROJECT VALUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
BUILDING El PLUMBING El MECHANICAL El DEMOLITION 11 ENGINEERING El FIRE PREVENTION
NAME OF PROJECT
o C-6)
PROJECT DESCRIPTION
0, Rt"t \."(p A'40
Detailed description of work to
be included on this permit only
-3
NAME
PRIAMRY PHONE
PROPERTY OWNER
NLAILING ADD
E-MAIL
CITY r,
t
ZIP go
PHONE,
xAnjNG ADDPZSS ?�-j tt" Aa4- E.,
010
CONTRACTOR
t
'7B,
"190
FAX
WA STATE CONTRACTOk-S LICZN$Z
EXPIRATION DATE
URI
NAME T'e _f(^
PRIMARYPHONE
� C'
APPLICANT
ALAUJNG ADDRT
t.At
F-MAIL
"E'A ItAt of a V-/
STAT
ZIP,
FAX
NAME;`'P7777i
I D 9 1,
PROJECT CONTACT
NUUUNG ADDRESS
E-MAIL
(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
(RCW 19.27.095)
umuNG 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. Z 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.
Iftirther 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 fled 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
as Part Of this application -
SIGNATURE: DATE
PRINT NAME:
mm
NRAV
I ra
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $
Indicate how many of each type of fixture to be installed or relocated as part of this pro Lect. Do not btelude e)dstirkq ixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (commerc9al)
BOILERS FURNACES HOT WATER TANKS (Gas)
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES
VALUE OF PLUMBING WORK
PLUMBING PERMIT
Indicate how many of each type offixture to be installed or relocated as art of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/Sh..—C—bo) LAVS (H—dSinks) TOILETS WATER PIPING
DISHWASHERS RAINWATER SYSTEMS URINALS OTHER (Describe)
DRAINS SHOWERS VACUUM BREAKERS
DRINKING FOUNTAINS SINKS (xltchen/Ut&ty) WATER HEATERS (Ei—t-)
HOSE BIBBS SUMPS WASHING MACHINES TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF EXISTING IMPROVEMENTS
EXISTINGIPREVIO USE *'
LOT SIZE (I- Square Feet)
EXISTING FIRE SPRINIMER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
a.,,.,; •i "
❑Yes ❑ Na
❑ Yes No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
BASEMENT
FIRST FLOOR (or Mobile Home)
SN
L .-
i.
----------------------------------------------------------------------------------------------------------------
SECOND FLOOR
COVERED ENTRY
DECK
------------------------------------------------------------
GARAGE OK CARPORT ❑
Wil
OI IEit*. (cry 3...' ,.... ,... r_
-------- ----- - -- —
Area Totals
ER[3TING
PROPOSEYf
TOTAL
---_.--- -------- __--_..__..-.. _.-----..__--_.—
**JwwJ%("w9
(>JYLY**
ESTIMATED SELLING PRICE
I # OF BEDROOMS
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
# of
Stories
Additional Information
NEw BUILDING
ADDITION
COMIYImmL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
§q�e Feet
Occupancy Group
us) Const ection
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY