08-101872My OF "� N'0 � $•B Kin i ! S g Fire ® e & tl i ♦f-i tc .
Federal Way `��ECEIVED �rOved -J
1E,M� SF MF CO ME EL PL DE EN4EP
COMMUMnY OEVUOPAIENT TER VICESyy� pp y pp .� �} I _
33325 DERALAVENUE WAY.
98OW OX RR 2 1 ZooAP�t � : •,d °��l -01' '. T.-O;N
FEl]ERAL fYAY, fVA 98083-9718� Y .iF.-• L 1 1
253-835-2607- FAX 253-835-2609
w-n-L inwkthImIgony, m OF FEDERAL. WAl'-
The following is required ir#_bgnation - an*c mplete application will not be acce Please print legibly (in ink) or type.
-- Q11rM `%MCQ AMC 00ni ilocn 1ki A 1 1
SITE ADDRESS «J F_ A VIE- h 11 A I
I N WNUrit Y
ASSESSORS TAXIPARCEL # � I I REQUIREMEWS
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lengthy legal desafptfaN
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING eVIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide delaaed scrlption of work included on 0iispermIt onlld
a�•r��'rr,:c0c:� %r tea oar 6?22,- L4,
ati o CZ
i►9frll7` Gt,40(�rfC �fe r/-era' Zvi �+l —fie
PROJECT NAME (Name of Business or Owner Last Name)` 5�/�.t/l Ar
PROPERTY
OWNER
CONTRACTOR
V/Dt'
APPLICANT
PROJECT
CONTACT
LENDER
xm
NAME
PRIMARY PHONE
MAJUNG ADDRESS
S.
Crly-STATE. ZIP
E-MAIL ADDRESS
334v,,-
a% dr/�
o Cal f cou„
COMPANY NAME
� � 1
AP CANTNA�MEE
.4✓� / ✓�/Wi�1v,,
rOr'HC:E PHONE
i3) 9 &3
- S7
MAILING AD?If,4
of rye '�-
CnY. STATE. ZIP
I wrap 225
CELL PHONE
(Z53) &K
- W7(5
CITY OF FED • AY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
383
-&3 7.3
CONREGISTRATION�..7�� !NUKBFR
CrCr
EXPIRATION D16
3
E-MAIL ADDRESS
COMPANY NAME
Af•+P AC:ANT NAME
1 eO e
OFFICE PHONE �1
9IUNG ADDRESSOF
�• �
CONE
�o
.
�71P
-
RE[ATIONSHIPTO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant Agent ❑ Other
NAME
NAME Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS I CITY, STATE, ZIP I PHONE
EXISTING USE ,v/14 PROPOSED USE" 13r' ;M 7Ti►QfG� �/r7�yCt�/Vf� fQ
EXISTING ASSESSED/APPRAISED VALUE $ All VALUE OF PROPOSED WORK $-
SPRINKLERED BUILDING? z ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? L ES ❑ NO
WATER SERVICE PROVIDER > HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER E LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
1
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
FIRST
� �✓ea• Csvry
� z �S
i z ��
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
Effi5fmc
PROPOSED
1OTAI
FJV317)PG Sx
TOTAL PROPOSED SF
/ TOTAL SF
f
**NEW HOMES ONLY** NUMBEROF BEDROOMS , /�/ - ESTIMATED SELLIINNG PRICE $
Indicate number of each type offudure to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE 17VCLUDED WITH APPLICATION1
EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
FANS GAS WATER HEATERS MISC (Describe)
FIREPLACE INSERTS HOODS (Commercial)
FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
LAVS (Bathroom Sinks) URINALS MISC (Describe)
RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS (Toilet)
SINKS WASHING MACHINES
SUMPS
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 authorized 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 apart of this application.
SIGNATURE:
Authorized Agent
r
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 — January 1, 2008 Page 2 of 4 k\Handouts\Permit Application