08-101874clwo A
ONED 0
FeaeraI wa PERMIT ,�-�
CaAlM1fllA'fIY DE VEfAPhlF.4T SERVICES , {{�� p SF MF CO ME EL PL DE EN
33325 U+N AVENUE Sf7fI1N • PD 80X �7� � �, 2�U 0
FEDERAL WAY, WA 98063�7IA AP P LI CATI ON ro
253-835-2607• FAX 253-835-2609
ilviira. rlhm7ndrmlrlirrn.mm r„FC:TZG RAI WAY
The following is required iTOb3�ation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS �`�J Y , ✓� 7- SUITE/UNIT #
ASSESSOR'S TAX/PARCEL # 27 I I - [J Q LOT SIZE (gfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)�GGI/rl/1
(Attach separafe pagefor lengthy legal descrlptlaN
PROJECT• •
TYPE OF PERMIT [I BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING OlhRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit only)
C��?`? 'r ►or/i Ce- Ad,,,; o , _ A,- .�—ICb r we�a f
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
E PEOPLE INFORMATION
NAME
PRIMARY PHONE
MAILING ADDRESS CITY, TATE. ZEP
336 S• !�/�
ErMAILADDRES:S
f
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� ��
COMPANYNAIME
��h-1
APPf]CAN TNAME
/AI-1
3kV,--
Z63) 3j
O(�FFICEPH�ONE
- .
AD RJLSS
�y
CITY. STATEr ZIP
CELL NEM1NLING
/
' C&
/"40-�2-z:
CITY OF FEDE. VAY BUSINESS LICENSE nIIh58ER
IRATION DATE
&-- -
FAX NUMBER
1 (-,:-!�'3) 383
-23 73
CON, R-.1CTDIt'S ItCGI5Ti{ATI0 NVMBEft
EXPIRATION D4TF1
E-KIIli. ADDRFSS
CIGT C 3I6G�
/-3/- 16
,G
COMPAN:" N 1AIF
APPLICANT NAME
SL> a e
OFFICE PHONE
(53) Z135-
MAILING I
9
�3 ��. � �e
Y. '<
�a 9 7�
a
a
uz� �
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(�3CELL )n.r
-
F2C! 'M ONSHIP TO PRO.I ECT
FAX NUMBER
❑ Architect ❑ Tenant ZAgent ❑ Other
NAME P RWARY PHO I,E E-MA] L ADDRESS
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
DETAILED BUILDING INFORMATION
EXISTING USE PROPOSED USE lirl I-• j 1 �+r1G r __ rj_
EXISTING ASSESSED/APPRAISED' VALUE S � VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ NO
WATER SERVICE PROVIDER HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER id HAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
SQ. FT.
BASEMENT
FIRST
SECONDAjA�L �A t/
�7 287
/7
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
Effi-
PROPOSED
TOTAL
z
TOTAL E%rSTING SF
/7,!NZ
TOTAL PROPOSED SF
T 297
Gv
f
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
11111110 11111111110
Indicate number of each type of fixture 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
va*0%?lA-1aYtA
BATHTUBS (or Tub/SbowerCombo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAVS (Bathroom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (Commercial)
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (ronet)
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
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, orfederat 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, bat 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.
SIGNATURE:
Authorized
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