10-102284r,
RECEIV 1D U U '�
♦ /0 _
My OF JUN 0 X 7�'1l
Federal way PERMIT — — — — — — — —
"MMUMTYDEVE�P s R,v,1� SF MF CO ME EL PL DE ENS
25ST'tAVENUE�O�BQX�38 FEDERICATION r
.-.. FEDERAL WAX.�4 9 0 9
253-835-2607• FAX 253-835-2609�'^
www.cifyoffederalwati.com t" -"D S
The ollowin is re aired in ormation -an incomPleteapiLikation will not be accepted. Pleaseprint le ibl Cm ink) or
�7 PROPERTY AV
SITE ADDRESS 761 S, 3 2, V 37 FED EAL WJ`,ir - SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # I ® �r�I� - (7C� t , / I LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (� E ► l —FU ` V �' T� Q1 V '-+r 2-
(Attach separate pagefor lengthy legal descrottan)
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )( FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descLp� �o�workcintci�udle7d(on this eEit on1
Zl�'t[`C� LT /SIL �/\t t(-ICJC` 11� JI r 1 C �- J ! 1 l /�LEIZ SYSTEM I`FFPA 13,
PROJECT NAME (Name of Business or Owner Last Name) iO U ` -'S Ay I D ` GAP ` 157 C H UY-14
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME PRIMARY nL) I l S A V O ( I l (S DAP 1 I -ST L H V! if LT lL.�-_ -3) PHONE
- 6-,�g Z C
MAILING ADDRESS CITY, STATE, ZIP
Ta i -'S3 Z0 -m STREET FtD EiZAL WAY 'WA 9 9003
COMPANY NAME
C6LL)MB(A FIRE
APPLICANT NAME
MAN SL-tL)LZE
OFFICE PHONE
(2z)Z3Z -
MAILING ADDRESS
1 !33 zt F I RSC AVE S
CITY, STATE, ZIP
-SEA LE WA
CELL PHONE
(266) Z Z -552�o'l
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
Z -0cL-1 Q 0-j- 5--7-"PB
EXPIRATION DATE
12 /31 /ZDID
FAX NUMBER
Q;G040 -6iG0
L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
L Q L LJ H FZ9 5 Z Nl &
EXPIRATION DATE
COMPANY NAME
COLUh'1131A FIRE
APPLICANT NAME
L3iZ1a4M SL- L)
OFFICE PHONE
(20232 -256L9.
MAILING ADDRESS
1534 FIRST AVE 5
CITY, STATE, ZIP
SALE UA-
CELL PHONE
(�) Z3Z - 95L"T
RELATIONSHIP TO PROJECT
❑ Architect 13 Tenant ❑Agent ❑Other (Describe) DE-S`LYNLC(
FAX NUMBER
g/fr� ):540
P E-MAIL
NAME lL..t..CLIY) C— - aaGl LJI\L/YIiSL/L_L/� r �A
C31ZL/�N SCtIULZ�
Per RCW 19,27.095: Lender igfOrMation is
required jfj)rq)eet txttue exceeds $5,000
NAME P
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
V:XISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $.
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
SQ. FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT
DRINKING FOUNTAINS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
FIRST
BBQS
FANS
HOODS (commer(:ial)
SECOND
FIREPLACE INSERTS
RANGES
COMPRESSORS
THIRD
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
FOURTH
DEMO PERMIT REQUIRED?
❑ YES
c NO
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
E]OSTMG
PROPOSED
TOTAL
TOTAL EXISTING SF
TOTAL PROPOSED SE
TOTAL SIS . .
—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.
MECHANICAL Z f3 OCA
SHOWERS
WATER CLOSETS troiici)
Value of Mechanical Work $
SINKS
DRINKING FOUNTAINS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
BBQS
FANS
HOODS (commer(:ial)
BOILERS
FIREPLACE INSERTS
RANGES
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
o YES o NO
BATHTUBS (nrTub/Shower Combo)
SHOWERS
WATER CLOSETS troiici)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAYS (Bathroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
REFRIG, SYSTEMS
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 ./r L%�/ � �/ �.!� // d�i DE—C.J H EER DATE
(Signature) (Talc)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
❑ NEW � ADDITION
❑ ALTERATION
G REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
c YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑-YES
c NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU?
❑ YES
c NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
❑ YES
c NO
Bulletin #100 — January 1, 2006 Page 2 of 4 k\Handouts\Permit Application