07-103295Federal Way PERMIT
COMMUNIT1'DEVELOPI-BM'SERVICe�UN 1 8 2007 SF MF CO ME EL PL DE ENE)
33315aAVENUE+ry.%VA r.ronoes:,s APPLICATION
FEDEvE OU 38
03M OF
uwr•I .�,t cdcmiunl.ral WILDING DEpT
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The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
F'
SITE ADDRESS z i i0 Fr - "" may,
ASSESSOR'S TAX/PARCEL # Q -
cibc
b y
SUITE/UNIT #
LOT SIZE (s )
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal descrotloN
PROJECT• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
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PROJECT NAME (Name of Business or Owner Last
PROPERTY
OWNER
K CONTRACTOR
COPY -rear a
with each
= - APPLIC
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
i LLnit
FAIMARY PHONE
UD6 )c I — i'OD
MAILING ��ArrD��DRESSnn
CITY, STATE, ZIP
E-MAM ADDRESS
COMPANY NAME
�(
nave alIANT NAME
OFFICE, PHONE_
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MAILING ADDRE/'S�S
CITY. . ZIP
PHONE
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CRN'�TRAC'P6Ir8 REG3, W]UNTIO�Ns NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
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p/
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COMPANY NAME
APPLICANT RfAIufE
OFFICE -PHONE, �
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MAILING ADDRESS d
CITY. STATE. ZIP
CELL PHONE
RELATIONSHIP*M PROJECT
h)
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent f)7 Other
[ -
NAME PRIMARY PHONE E-MMLADDRESS
bcas (UAL l 'f3 - Cb u,:? 9s uL��(c C
NAME
Per RCW I9.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY. STATE. ZIP
PHONE
EXISTING ASSESSED/APPRAISED VALUE S
PROPOSED USE
VALUE OF PROPOSED WORK $'S r
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRlri'ION EXISTING PROPOSED
S . FT. S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
\
1
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
EffiSfING
NUMBER OF FLOORS
PROPOSED
TOTAL
70TAL EXSI'ING SF
\ TDTAL PROPOSED SF
11DTA7. SF'
"NEW HONES ONLY" NUMBER OF BED q S ESTIMATED SELLING PRICE $
Indicate number of each type of jvaure to be u%srauea or retocarea as pan of t us project. uo noL uictuae exisung jixiures ro remain.
MliANICAL
Value of Mechanical Work $ (A COPY ID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORt1I'IVE C EitS GAS P OUT_Lff WOODSTOVES
BBQS FANS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (Commercial)
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS (or Tub/Shower Combo) LAVS I
DISHWASHERS A
DRINKING FOUNTAINS HOWE
ELECTRIC WATER HEATERS SINKS
HOSE BIBBS SUMPS
n Sinks)
SYST
WATER CL CTS (Touep
WASHING MA INES
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
rm haless 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. f
NAME/TITLE JU ? irV _ �kC I It 1 I - '� , r: f 1 } DATE
I (Sigmt" (Mile)
RELATIONSHIP PROJECT ❑ Owner ❑ Agent *Contractor ❑ Architect ❑ Other
FOR OFFICE USE ONLY, ,
❑ NEW ❑ ADDITION
❑ 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