08-104974 r
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Federal Way 7e
COMMUNITY DEVELOPMENT SERVICES OCT 21 2008 P E RM I T SF MF CO ME EL PL DE EN 33325 8.,AVENUE SOUTH•PO BOX 9718
FEDERAL WAY.
35-2 07.F 14258063.9718 AP P I�. ATI O N L-
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OF F E D E RA L
The following is required info€ &-an incomplete application will not be accepted. Please print legibly(in ink)or type.
IN PROPERTY INFORMATION
SITE ADDRESS_ .32.0Z1.? 32 444_ •4,►.�, .S SUITE/UNIT it
ASSESSOR'S TAX/PARCEL# - LOT SIZE(s,f) 1536 %O f•
LEGAL DESCRIPTION(e.g.Acme Estates,Lot 1) =vrop„_ Sy,. 0,.,,t t.
(Attach separate page for lengthy Icyal descr[ptioy
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION(Provide detailed description of work included on this permit onlu)
INI- Nitsterv, T/1- 9 _Sr•oker D�.fie.cters
I 4• .4 Ac}-ccto.•'
? 4.v1:b(,`Jv:Suc..
PROJECT NAME(Name of Business or Owner Last Name) E vro4_ 'EYE. (...i.,,,,-L. Dr j_-e.`_
is PEOPLE INFORMATION
PROPERTY NAME !� PRIMARY PHONE
OWNER ees r�t ?C.-K ( ) -
MAILING ADDRESS CITY,STATE.ZIP E-MAIL ADDRESS
CONTRACTOR COMPANY NAME APPLICANT NAME OFFICE PHONE
Sc,.m-r Ft,ti 4 5w,r:iy (..t_� 5.4c' 801.ssc..-A (42' ) 24 y -1yH<
MAILING ADDRESS CITY,STATE,ZIP CELL PHONE
1')G10') ti-iii, Au_ i' Art4.5tw. WA 5'322'3 (424,') 24111 -Iyll 5-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER IRATIO DATE FAX NUMBER
®'1'. lea 6"1 c-®cam PZ �( �� (. /.0 )wc,3 -10,K-
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E-MAIL ADDRESS
131viRSF5°I'31 w►L (ofe ffrri?vcirt11.v.e:sov1,inZt"?
APPLICANT COMPANY NAME APPLICANT NAME OFFICE PHONE
MAILING ADDRESS CITY.STATE.ZIP CELL PHONE
RELATIONSHIP TO PROJECT FAX NUMBER
❑ Architect o Tenant ❑Agent L Other .Sutij Lunt ro.c_tc:nr ( ) -
PROJECTNAME�r G� PRIMARY PHONE E-MAIL ADDRESS
CONTACT C �r'0 Sg�r (42s)P1-4( - 14,14 q' b�►^I',w C4c-CO W..\?-1,0: r
LENDER NAME N(P., Per RCW 19.27.095:
Lender information is required if project value exceeds$5,000
MAILING ADDRESS CITYY,STATE,ZIP PHONE
( )
• DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE
T�
EXISTING ASSESSED/APPRAISED VALUE$ VALUE OF PROPOSED WORK t3,1
W�, VC
SPRINKLERED BUILDING? ❑YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSE WIRED? ❑YES ❑ NO
WATER SERVICE PROVIDER o LAKEHAVEN ❑ HIGHLINE o TACOMA ❑ PRIVATE(WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE(SEPTIC)
• PROJECT FLOOR AREAS
AREA DESCRIPTION EXISTING PROPOSED TOTAL
SQ.FT. SQ.FT. SQ.FT.
BASEMENT
FIRST
153eg
SECOND
THIRD
ADDITIONAL FLOORS(DESCRIBE)
DECK(❑COVERED OR ❑UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS EXISPING PROPOSED TOTAL TOTAL=STING SF TOTAL PROPOSED SF TOTAL SF
**NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
• FIXTURES
Indicate number of each type of fcrture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work$ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC(Describe)
BOILERS FIREPLACE INSERTS HOODS(commercial(
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG.SYSTEMS
PLUMBING
BATHTUBS(or Tub/Shower Combo) LAVS(Bathroom sinks) URINALS MISC(Describe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS(Toilet)
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
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 authorised 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 information supplied to
the city as a part of this ap cation. /016 SIGNATURE: DATE f0I Z1 6
Property Owner and/or Authorized Agent
FOR OFFICE USE ONLY
❑NEW ❑ADDITION o ALTERATION 0 REPAIR ❑TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑YES ❑NO BASIC PLAN? ❑YES ❑NO
ZONING DESIGNATION CHANGE OF USE? ❑YES ❑NO
NEW ADDRESS REQUIRED? ❑YES o NO UP/SEPA/SU? o YES ❑NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES ❑NO
Bulletin#100-January 1,2008 Page 2 of 4 k\Handouts\Permit Application