07-102455 (2)CITY OF `� h 3p�� — i
Federal VNa�► V �,,,� PERMIT
W SF MF CO' ME EL PL DE EN FP
COMMUNITY DEV,SLOPNFM� SERVIC$S, �,���.�
3332FS^lAVENUE., WA !a }7b$ 7tiL APPLICATION
FEDERAL WAY, WA 4 ,F�
253-835-2607• FAX 253.1335-3
priv
The followingyis req*41� ,ation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
ASSESSOR'S TAX/PARCEL # V 7 _j V
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Alta h separate page far lengthy legal descrlpilon)
PROJECT• •
TYPE OF PERMIT "_ i IIING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed descriptton of work included on this permit ontu)
PROJECT NAME (Name of Business or Owner Last Name) \1_1tf I I 1 I - G l L- C-4—
PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
COPYof ..rd regw.ed
Wilk e..h.ppllo.[lon
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
) `[V / -
H
rl6&1
T L AD�/` l V! I 1 tiA `CITT STATE�7.1F1 ']I' qW I CELL PRONE
sO b L �S'3 ) �S-0- 3
ZONATION D E r,0L;etIM
ADDR
Vv (i-040 Iq
COMPANY NAME
APPLICANTNAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
N g Ll i• -I I ADDRESS 11 IVL/ FrJM
7
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $��
FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ N
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC) �[
l>
AREA DESCRIPTION EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
89. FT.
BASEMENT
I
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EIaSTINO
PROPOSED
'rV'lIW
TOTAL E7[WTTLY09P
TOTAL PINNI N&I BF
TOTAL BF
*"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE
Indicate number of each type of f xture to be installed or relocated as part of this"rofecl.1bo not include existing jixhlres to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST ! INC . ED WITH APPLICATION)
F
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE ❑ WOODSTOVES
BBQS FANS GAS WATER HEATE MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (or Tub/Shower Comm)
LAVS (Bathroom 911
URINALS (Describe)
DISHWASHERS
RAINWATER S.
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrmieu
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
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 FiederaI 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, andfiled against the City of Federal Way, but only where such claim
arises out of the reli of the city, incl lag its officers and employees, upon the accuracy of the information supplied to the city as apart of
this application. t
NAME/TITLE DATE
TO PROJECT ❑ Owner agent ❑ Contractor if Architect ❑
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN? ❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? ❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP/SEPA/SU? ❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED? ❑ YES
❑ NO
Bulletin #100 — April 2, 2007 Page 2 of 4 k\Handouts\Permit Application