21-100063-SF-Building Permit Application40k
CITY OF
Federal Way
PERMIT NUMBER
PERMIT APPLICATION
PERMIT CENTER + 33325 81h Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcenter��cityoffederalway.com
_ _L a _Q O -(,0- -a - ts ! TARGET DATE T_/_3 D
SITE ADDRESS
SUITE/UNIT N
1 q j F rci I CAL qb Oa-3
PROJECT VALUATION
ZONING
ASSESSOR'S TAIL/P EL M
$ y0 OUv
RS1.9
q 3 2-- _q -3- O
TYPE OF PERMIT
IJ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
0 Gict r cc 4 R ; . t 0n
PROJECT DESCRIPTION
o CL rd ( in a
Detailed description of work to
a(
be included on this permit only
PROPERTY OWNER
NAME
O
PRIMARY PHONE
, - l
MAILING ADD
sw
E-MAIL
am. parite o CORE. oeA
CITY
F d¢ra a,o
STATE
ZIP01
NAME
• i t�
PHONE _7
MAILING ADDRESS
F-MAIL
CONTRACTOR
CITY
STATE
ZIP
FAX
WA STATE CONTRACTOR'S LICENSE N
EXPIRATION DATE
UBI N
NAME ++ //
OCS l.i L C
PRIMARY PHONE
MAILING ADDRESS
N - S
E-MAIL
D CS -
APPLICANT
CITY
STATE
Wqr
ZIP
a00oo
FAX
PROJECT CONTACT
NAME
00
PRIMARY PHONE
- l , L4 6
(The individual to receive and
respond to all correspondence
MAILING ADDRESS
u.h u(r)
E-MAIL
t) - T,>d 11+,
CITY STATE
ZIP
FAX
concerning this application)
PROJECT FINANCING
NAME
OWNER -FINANCED
When value is $5,000 or more
(RCW 19.27.095)
MAILING ADDRESS, CITY, STATE, ZIP
PHONE
1 certify under penalty of perjury that 1 am the property owner or authorized agent of the property owner. I certify that to the best
of my knowledge, the igformation 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.
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
ir{formation supplied tot city as apart of this application.
r
SIGNATURE: DATE �) �7 1 ZO Z�
PRINT NAME:
0
Bulletin # 100 -February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
MECHANICAL PERMIT
Indicate how many of each type offixture 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
PLUMBING PERMIT
Indicate how many of each type offixture to be installed or relocated as part of this project. Do not include e x-isting 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?
0
WATER PURVEYOR
#�
SEWER PURVEYOR
fe
VALUE OF EMSITNG IMPROVEMENTS
$
EXISTING/PREVIOUS USE
LOT SIZE (In Square Feet)
-
EXISTING FIRE SPRINKLER SYSTEM?
PROPOSED FIRE SUPPRESSION SYSTEM?
10 E��
❑ Yes No
❑Yes . No
RESIDENTIAL - NEW OR ADDITION
AREA DESCRIPTION (in square feet)
EXISTING
PROPOSED
TOTAL
FOR OFFICE USE
...............................................................................................................................................................................................
...............................................................
...............................................................................................................................................................................................
................................................................................._................................... .........................................................................
BASEMENT
� o
FIRST FLOOR (or Mobile Home)
t::50 0
SECOND FLOOR
0
COVERED ENTRY
J..570
DECK
1.4 0
GARAGE *4 CARPORT ❑
e7 n
'Z '?7
`
79 :7
OTHER (describe)
Area Totals
ERI ING
� �
PROPOSED
� •-�
TOTAL
��
**Ja w gyro
s oxLT**
ESTIMATED SELLING PRICE $
# OF BEDROOMS
COMMERCIAL— NEW/ADDITION
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
NEW BUILDING
ADDITION
COMMERCIAL -- REMODEL/TENANT IMPROVEMENTS
AREA DESCRIPTION
Area in
Square Feet
Occupancy Group(s)
Construction
a
# of
Stories
Additional Information
TOTAL BUILDING
TENANT AREA ONLY
PS'ojzcT AREA ONLY
Bulletin # 100 — February 19, 2020 Page 2 of 2 k:\Handouts\Permit Application