04-103021 (2)PROPERTY INFORMATION
PROJECT,IXFORMATION
. . ........ •
IN I
PEOPLE INFORMATION
--- --------
DETAILED BUILDING
INFORMATION
EXISTING USE Retail St,r. e
PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE 3,690,000.00
VALUE OF PROPOSED WORK $239,480.00
SPRINKLERED BUILDING? x YES ONO FIRE SUPPRESSION
SYSTEM PROPOSED/ REQUIRED? 0 YES ONO
WATER SERVICE PROVIDER K LAKEHAVEN o HIGHLINE
o TACOMA o PRIVATE (WELL)
SEWER SERVICE PROVIDER N LAKEHAVEN 0 HIGHLINE
0 PRIVATE (SEPTIC)
12
project. not
Indicate number of each type of,rixture to be installed or relocat this 7-oject. Do: rinclude existing fixtures to
MECHAWCAL
Value of Mechanical Work
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REFRIG. SYSTEMS
- ------- ---- - BBQS
FANS
HOODS (Commercial) WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
BATHTUBS (Tub/Shower Combo) SHOWERS WATER CLOSETS {Toiiet} _ MISC (Describe)
DISHWASHERS SINKS DRINKING FOUNTAINS
GAS PIPE OUTLETS SUMPS RAINWATER SYST
WASHING MACHINES URINALS HOSE BIBBS
LAYS aoh'.Q. S. A VACUUM BREAKERS ELECTRIC WATER HEATERS
I cert�N under penalty ofperjury that the information furnished by me is true and correct to the best of my knowledge, and filirther, 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 (ineZuding costs, expenses, and attomeys'fees incurred in the investigation and defense of
%j*40jF# neo and qled against the City Federal Way, but only where such claim
lly T4- 4gM
artsff'"j the reliance oj Me ciry, InCLUUIrLy anu
this application.
NAME/TITLE . Monty D.• DATE
•
Nignaturt) a mtles
RELATIONSHIP TO PROJECT o Owner 0 Agent [X Contractor 0 Architect Ei Othe
FOR OFFICE USE C;)_NNL�Y�
o NEW o ADDITION b ALTERATION o REPAIR ci TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? 0 YES c NO
ZONING DESIGNATION CHANGE OF USE? o YES o NO
NEW ADDRESS REQUIRED? o YES o NO UP/SEPA/SU? 0 YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT RkQU!Rkb?� 0 YE3 0 NO
Bulletin #100 —March 30, 2004 Page 2 of 4 k\Handouts — Revised\Permit Application