07-106559CITY Of
Federal Way RECEIVEWERMIT
COMMUNITY DEVELOPMENT SERVICES
3332S 8r" AVENUE SOUTH • PO .VOY 9718
FEDERAL 7Y DECO AP P L I C AT I O N 53 8 5- 260PAX 253 835 2609
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FI CO ME EL PL DE EN (IJ
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CITY OF FEDERAL WAY /
The following is required "00j& O-')an incomplete application will not be accepted. Please print Iegibly (in ink) or type.
1 - • •c •
SITE ADDRESS _ �� I V' � V 1 r 1 Co r ►r , oy) -7 SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # (— ? Z `{ �'� - Q O ( Q LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal d --ipdo q
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING YLFIRE PREVENTION SYSTEM
PROJECI D CRIPTION (Provide detail d description of work included on this permit onlu)
PROJECT NAME (Name of Business or Owner Last Name) Famous
PEOPLE •- •
PROPERTY
NAME
PRIMARY PHONE
OWNER
n�
253) _
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AIL NG AD-
,PRE
CITY, STATE, Z
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E -MAIL ADDRESS
CONTRACTOR
COPY of eard requlred
with each applteati_
APPLICANT
PROJECT
CONTACT
LENDER
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
fri toy) 171 V.
CITY, STATE, ZIP -
W ZS) t� - 76k V
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CITY, ZpIP
Il rLe
CELL PHONE
'
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
'S - &T66 - c>b
( 2 -.� % - a 8
(1/5) 1s1 -
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
CMCWWVy0q
C CYOLM( P. C
COMPAN}YY NAME � ME
f ' e_ V''s y1
APPLICANT NAME
/OFFICE PHONE
t 1 -
MAILING ADDRESS
CITY, STATE, ZIP -
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
N E - PRIMARY PHONE E -MAIL ADDRESS
S I ) _Ibld i
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE ����\ PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $
SPRINKLERED BUILDING? /i YES O NO
WATER SERVICE PROVIDER ❑LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
VALUE OF PROPOSED WORK $���, l0
FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO
• HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
• HIGHLINE ❑ PRIVATE (SEPTIC)
►M
AREA DESCRIPTION
EXISTING
SO. FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT
FIREPLACE INSERTS
COMPRESSORS
FURNACES
FIRST
GAS LOG SETS
G
4
.SECOND
LAYS (Bathroom Sinks)
DISHWASHERS
RAINWATER SYST
THIRD
SHOWERS
ELECTRIC WATER HEATERS
SINKS
ADDITIONAL FLOORS (DESCRIBE)
SUMPS
CHANGE OF USE?
v YES
DECK (0 COVERED OR ❑ UNCOVERED ?)
NEW ADDRESS REQUIRED?
o YES o NO
GARAGE ❑ CARPORT ❑
11 YES
4.
PLATTED LOT?
NUMBER OF FLOORS
Emsrino
Psoroau
TOTAL
TOTALE.T7 -Sr
TOTAL PROTOMMO Sr
TOTAL Sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain
Value of Mechanical Work
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS.
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS LOG SETS
G
o REPAIR o TENANT IMPROVEMENT
BATHTUBS (or Tub /Shower Combo)
LAYS (Bathroom Sinks)
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ELECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (comm�r�eq
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (Toileq
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is 'true and correct to the best 'of my knowledge, and further, that I
am authorized by the owner of .the above premises to perform the work for which the permit application is made. 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 of Federal Way, 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.
NAME /TITLE J. �C/
(Signature)
RELATIONSHIP PROJECT O OWner O Agent
DATE 1�
(Title)
A.C'ontractor o Architect o Other
- q- 0
-1
7/
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES o NO.
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
v YES
a NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU?
11 YES
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
a YES
o NO
Bulletin 11100 —April 2, 2007 Page 2 of 4 k \Handouts \Permit Application