20-101874-Building Permit Application40111
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Federal Way
PERMIT APPLICATION
PERMIT CENTER + 33325 811, Avenue South + Federal Way, WA 98003-6325
253-835-2607 + FAX 253-835-2609 + permitcentet@cityoffederalway.corn
PERMIT NUMBER _ _
— TARGET DATE
SITE ADDRESS
SUITE/UNIT #
PROJECT VAALUUATION
ZONING
ASSESSOR'S TAX/PARCEL #
TYPE OF PERMIT
BUILDING PLUMBING ❑ MECHANICAL 0 DEMOLITION ❑ ENGINEERING ❑ FIRE PREVENTION
NAME OF PROJECT
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PROJECT DESCRIPTION
Detailed description of work to
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be included on this permit only
NAME
PRIMARY PHONE
PROPERTY OWNER
MAILING ADDRESS h
E-MAIL
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MAILIN DRESS
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E-MAIL
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CONTRACTOR
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FAX
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WA STATE CONTRALTO S LICEN
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EXP� TION DATE
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NAM
PRIMARY PHONE
APPLICANT
MAILING ADDRESS
E-MAIL
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ZIP
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PROJECT CONTACT
NAME
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PRIMARY PHONE
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MAILING rADDRESS
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E-MAIL
(The individual to receive and
respond to all correspondence
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STATE
ZIP �I
FAJA y $p
concerning this application)
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PROJECT FINANCING
NAME
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p, OWNER -FINANCED
When value is $5,000 or more
MAILING ADDRE S, tITY, STATE, ZIP
PHONE
(RCW 19.27.095)
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 regulation , 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 environment 1 laws.
I further agree to ho ar less the City of Federal Way o any claim (including costs, expenses, and attorneys' fees incurred in
the investigation an efense of
such ), which m e made '.by any person, including the undersigned, and filed against the city,
but only where s h claim rises f the reliance of the city, including its officers and employees, upon the accuracy of the
information su lied to the ity
p of this application.
SIGNATUR
Q�
DATE
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PRINT NAME:
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Bulletin #100 — February 19, 2020 Page 1 of 2 k:\Handouts\Permit Application
VALUE OF MECHANICAL WORK
MECHANICAL PERMIT $ 560
Indicate how many of each type of fixture to be installed or relocated as part of this project. Do not include existingjbqures to remain.
AIR HANDLING UNITS Z. 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
VALUE OF PLUMBING WORK
PLUMBING PERMIT
$ 3 J4c6
Indicate how many of each type offixture
to be installed or relocated as part of this project. Do not include existtn txtures to remain.
BATHTUBS (or Tub/showrCombo)
2. LAVS (Ilandsb*.)
�— TOILETS
WATER PIPING
DISHWASHERS
RAINWATER SYSTEMS
URINALS
OTHER (Describe)
DRAINS
SHOWERS
VACUUM BREAKERS
DRINKING FOUNTAINS
SINKS ptchen/utility)
WATER HEATERS (E ectric)
HOSE BIBBS
SUMPS
WASHING MACHINES
TOTAL FIXTURES
GENERAL INFORMATION
CRITICAL AREAS/ON PROPERTY? WATER PURVEYOR SEWER PURVEYOR VALUE OF EXISTING IMPROVEMENTS
Aa #&4AaAJ
EXISTING/PREVIOUS USE LOT SIZE (In Square Feet) EXISTING FIRE SPRINKLER SYSTEM? PROPOSED FIRE SUPPRESSION SYSTEM?
poor I+ALY-112ooc.. +A4-L ❑ Yes" , No ❑ Yes X No
COMMERCIAL — NEW/ADDITION
AREA DESCRIPTION
Area in
Occupancy Group(s)
Construction
# of
Additional Information
Square Feet
Type
Stories
NEW BUILDING
ADDITION
COMMERCIAL — REMODEL/TENANT IMPROVEMENTS
Area in
Construction
# of
AREA DESCRIPTION
Occupancy Groups)
Additional Information
Sauare Feet
Tvne
Stories
I TENANT AREA ONLY I a 6 4 C I A. "$ I 6 11 I
Bulletin #100 - February 19, 2020 Page 2 of 2 k:\Ilandouts\Permit Application