06-105562I . '
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Federal Way PERM1T
COMMUNITY DEVl?lOPME/'IT SEl?VICES · OCT 3 0 2006 · SF MF CO 'ME EL PL DE E
333258'"AV6NUESOU1'f/•POBOX97J8 ~I CATION
FEoeRAL wAr, wA 91i063 ·9A m1 F FED ·
253,835-2607• FAX 253-835·~1 l 0
tuww,cjtuofkclcralwg11.com BUILDING DEPT. o_/-0
The following is required information -an incomplete application will not b.; acc.epte1, Please~rint legibly (in in'/4 or type.
ASSESSOR'S TAX/PARCEL It __
SUITE/UNIT # ..:-.-=--...:c.
LOT SIZE (sf)
LEGAL DESCRIPTION (~.g. Acme Estates, Lot 1)-----------------------------
. • PROJECT INFORMATION
TYPE OF PERMIT D BUILDING D PLUMBING D MECHANICAL
D DEMOLITION O ELECTRICAL O ENGJNEERJNG "11RE PREVENTION SYSTEM
PROJEC
PROJECT NAME·(Name of Business or Owner last Name) __ :P,;__td.;::. ... _w::....•-=~l:t.:....:=L,-=---~,,.._.L.:~.=..=c·_;;; __ St-_...:...,\'-"£=-U....::..L __ ...;; ________ _
PROPERTY
OWNER
CONTRACTOR
. · • PEOPLE INFORMATION ·
M/\ll.lNG ADDRESS f"'t. .
l'-\2..f> · ">" -~us .
WAl'IYN/\ME ~ ~~. ~~~ :J~~"Ci~r>,
M/\ILINC /\DDe SS ~ k A--"' "!!J{"' ,ll>'L .i" tr , lP ~;T~,~ '~ps'L
PRIMARY PHONE
( . )
E·M/\IJ.. ADDRESS
(~~;a~ ..:. e, •~ .
C~tHONE (o r 5· i!l "?,'1..Dq.
CITY OF FEDERAL WAY Bl..!SINESS J,tCENSE MUMBBR EXPIRATIO f DATE F'~tBER •
\ '\-<\ "-toto4 "l lo l~l~t ii)~ ( . S) '18l -.do-:,~-
COPY of cud Nqul.Nd
with. !Uh •ppU~Mlon q
APPLICANT
CONTR/\CTOR'S REGISTRATIOtl NUMBER
~ t e;-; ~ l ~(,. Q...F'-
M/\ILINC ADDRES!.i.. J. i _ ._ \ --l\.&~ \,'t7·~ ~.
REJ..AT/ONSHIP TO PROJBCT
·o Architect o Tenant o Agent
EXPIRATIOI OA'f$ .,.,.,,,. ...
\,'l.../04
/\PPUCJ\NT HAMB/)
~L.,\~1-
ARY PHONE PROJECT
CONTACT ~:2~~~==!:=====~~S~1~.S.~~~-=i=1..=o~==~=~~~~~ .tt..s
l'IAME • Per RCW 19,27.09"5: LENDER
Le.ndedriforma.tton ts required if project value t!!XCeeds $5,000
MAILING ADDRESS CIT\', STATE, ZIP PHONE
(
EXISTING USE -------------------
. SPRINKL:ipRED BUil.DING?
EXISTING ASSESSED/APPRAISED VALUE $ VALUE OF PROPOSED WORK $ l\ ~.k ---------. . . I .
~S o NO FIRE.SUPPRESSION SYSTEM PROPOSED/R.EQU~D? ~
WATER SERVICE PROVIDER ~AKEHAVEN D HIGHLINE D TACOMA D PRIVATE (WELL)
D NO
SEWER SERVIC~ PROVIDER D LAKEHAVEN D HIGHLINE D PRIVATE (SEPTIC)·
AREA DESCRIPTION EXISTING PROPOSED TOTAL
s .FT. S . FT. .•FT.
BASEMENT
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (0 COVERED OR D UNCOVERED?)
GARAGE 0 CARPORT D
NUM~ER OF FLOO~S
t:XCS'rl~G PROPOSC6 TOTAL 1'01'AL £JUSTING sr TOTAL ,AoPoser, ST 1'01'AL 81'
•WEW HOMES ONLY"' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
. . • FIXTURES ·. -·------~--~-~-------·--------~------------------·--.. -....---------.
Indicate number of each type of fvct.ure to be in~talled or relocated as part of this project. Do not include existing fvdures to remain .
.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR EST!MA TE ·MUST BE INCLUDED WITH APPUCA TION)
AIR HANDLING UNITS EVAPORATIVE-COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS
-;-
MISC (Desciib.e}
BOILERS .. FIREPLACE j NSE'5TS ' HOODS (Comm.r<io.l)
COMPRESSORS FURNACES RANGES
DUCTS . OA~ LOG SETS REFRJG. SYSTEMS
PLUMBING
BATHTU.BS (or Tub/Shower CoCDboJ LA VS (B~rooa, Sinks) URINALS MISC (Describe)
DISHWASHRRS ----RAINWAT&R SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CWSETS (Toilet}
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
f:{OSEB!BBS SUMPS .
SIGNATURE ---------------·-·-----------------------------------------------
I certify under pena.lty of perjury that the tnforrnatlon furnished by me ts tn.le" and corrt!ct to the best of my knowledge, and further, that 1
am authorized by the owner of ths above premises to perform the work for which the permit application ts made. I further agree to hold
· harmless the pity of Federal Way· as to any claim (lru:luding costs, ~penses, and attorneys' fees incurred tn the investigation and defense of
such clalm), wlllch may be made.by.any person: including the undersigned, andflled against the City of Federal Way, but only where such claim
arises out of the reltan · city, including its officers and employees, upon the accuracy of the information suppli ed to the city as a part of
this application.
,NAME/TITLE ----'---"'---,.=...~--'-----------......:..--~' DATE t() -~£) -04_.
· (SignaturcJ frltlcJ f'L_.\)
R;ELATIONSHIP TO PROJECT o .Owner D• Agent D Contractor O Architect ~ther cS"~ -~ •
a NEW a ADD~TION o ALTERATION o REPAIR oTENANTJMPROVEMENT
BUILDING SHELL ONLY? o·YEs a NO BASIC PLAN? oYES a NO'
ZONING DESIGNATION CHANGE OF USE? oYES oNO
NEW ADDRESS ~QUIRED? oYES oNO UP/SEPA/SU? a YES a NO
PLATTED.LOT? o·m a NO DEMO PERMIT REQUIRED? a YES a NO
Bulletin# I'OO -January I, 2006 Page 2 of4 k\Handouts\Permit Application