21-102248-SF-Building Permit Application-06-12-2021-V1- 100 Permit ApplicationBulletin #100 – February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
PERMIT APPLICATION
PERMIT CENTER 33325 8th Avenue South Federal Way, WA 98003-6325
253-835-2607 FAX 253-835-2609 permitcenter@cityoffederalway.com
PERMIT NUMBER - -
TARGET DATE
SITE ADDRESS
33404 33rd Place South Federal Way, WA 98001
SUITE/UNIT #
PROJECT VALUATION
$ 8000.00
ZONING
RS9.6
ASSESSOR’S TAX/PARCEL #
6 1 _ 4 3 _ 6 0 - 0 4 _ 2 6
TYPE OF PERMIT x□ BUILDING □ PLUMBING □ MECHANICAL □ DEMOLITION □ ENGINEERING □ FIRE PREVENTION
NAME OF PROJECT
Apply Permit for Adult Family Home
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
Grab bars, Door handles, Ramp Installation to meet DSHS standards.
PROPERTY OWNER
NAME
Chol U Pak
PRIMARY PHONE
360-710-3450
MAILING ADDRESS
33404 33rd place south
E-MAIL
cjjpak@gmail.com
CITY
Federal Way
STATE
WA
ZIP
98001
CONTRACTOR
NAME PHONE
MAILING ADDRESS E-MAIL
CITY STATE ZIP FAX
WA STATE CONTRACTOR’S LICENSE # EXPIRATION DATE
/ /
UBI #
APPLICANT
NAME
Chol U Pak
PRIMARY PHONE
360-710-3450
MAILING ADDRESS
33404 33rd place south
E-MAIL
cjjpak@gmail.com
CITY
Federal Way
STATE
WA
ZIP
98001
FAX
PROJECT CONTACT
(The individual to receive and
respond to all correspondence
concerning this application)
NAME
Jenny Pak
PRIMARY PHONE
360-471-2072
MAILING ADDRESS
33404 33rd place south
E-MAIL
cjjpak@hotmail.com
CITY
Federal Way
STATE
WA
ZIP
98001
FAX
PROJECT FINANCING
When value is $5,000 or more
(RCW 19.27.095)
NAME
OWNER-FINANCED
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 c omply with
all applicable City of Federal Way regulations pertaining to the work authorized by the issuanc e 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 regulati ng
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 t he 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 5/24/2021
PRINT NAME:
Bulletin #100 – February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application
)
PLUMBING PERMIT
VALUE OF PLUMBING WORK
$
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
BATHTUBS (or Tub/Shower Combo) LAVS (Hand Sinks) 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?
Yes No
PROPOSED FIRE SUPPRESSION SYSTEM?
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 432sq
GARAGE CARPORT
OTHER (describe) Ramp
291sq
Area Totals EXISTING PROPOSED TOTAL
723sq
**NEW HOMES ONLY**
ESTIMATED SELLING PRICE $
# 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
MECHANICAL PERMIT
VALUE OF MECHANICAL WORK
$
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIR HANDLING UNITS FANS GAS PIPE OUTLETS OTHER (Describe)
AIR CONDITIONER FIREPLACE INSERTS HOODS (Commercial)
BOILERS FURNACES HOT WATER TANKS (Gas
COMPRESSORS GAS LOG SETS REFRIGERATION SYST
DUCTING GAS PIPING WOODSTOVES