20-103592-SF-Building Permit Application-09-21-2020-V1PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter@cityoffederalway.com
- TARGET DATE
SITE ADDRESS
MT1
PROJECT VALUATION ZONING ASSESSOR'S TAX/PARCEL #
$ Gel-,L
/ 3 0 C,%_06 ° irp 9 -a C?
TYPE OF PERMIT
�,UILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
; Z
PROJECT DESCRIPTION
Detailed description of work to
be included on this permit only
NAME PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS
EMAIL
V
C f STATE ZIP
L....ILJ
PHONE
MAILING ADDRESS _
1 ^ f M
E-MAIL
CONTRACTOR
)'4 ( -4,
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICE E #
EXPIRATION DATE
UBI #
NAME
PRIMARY PHONE
L-
APPLICANT
MAILI GA -- �
ry
E'-MAft,
C os cG
CI
STATE
ZIP � P
FAX
PROJECT CONTACT
N
PRIMARY PH NE
(The individual to receive and
MAIL ING ADDRES$
. - AG..
EMAIL
respond to all correspondence
j*
concerning this application)
crrY
sTATE
zrn
FAX
PROJECT FINANCING
AME
9'`OWNER-FINANCED
When Value 19.27.095J $5,000 or more
(RCW 1
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 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.
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 clainQ, which may be made by any person, including the undersigned, and flied 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:
it
Bulletin #100 -February 19, 2020 Pagel of 2 kAHandouts\Permit Application
MECHANICAL PERMIT
VALUE OF MECHANICAL WORK
Indicate how man o each type of fixture
to be installed or relocated as
part of this project. Do not include exisyng.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
PLUMBING PERMIT
1
VALUE OF PLUMBING WORK
Indicate how many of each e o
fftxture to be installed or relocated as part 9f this grgiect. Do not include exist'jgfixtures
to remain.
BATHTUBS (or fhb/Shower combo)
LAVS (Hand Sinks)
TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
_L,/' DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
�� SINKS (kitchen/Utility]
WATER HEATERS (gtectr c)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS ON PROPERTY?
WATER PURVEYOR
SEWER PURVEYOR
VALUE OF ER[STIIVG IMPROVEMENTS
EXISTING/PREVIOUS USE
LOT SIZE (in Square Feet)
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
❑ Yes ❑ No
❑ Yes ❑ No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
BASEMENT
FIRST FLOOR (or Mobile Home)
f 2
/
Z J
SECOND FLOOR
COVERED ENTRY
DECK
GARAGE ❑ CARPORT ❑
OTHER (describe)
Area Totals
*11iFm ann�c
E7Q8TII °
0r d
nmr.v**
PROPOSED
TOTAL
SELLING PRICE $ ( # OF
FOR OFFICE USE
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Grou s
PancY P()
Construction
Type
# of
Stones
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Grow s
P Pl 1
Construction
Type
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PROJECT AREA ONLY
Bulletin #100 —February 19, 2020 Page 2 of 2 k:\Iandouts\Permit Application