07-106778. A -In
PERMITpEC 17 2007. SF MF CO ME EL PL DE E FP
- COiiMUNITYDEYEIAPMBNTSERVICES
333 ?58ERUWISSOUlsI•POeox971d APPLI CATi
FEDERAL WAY, WA 93063.9719 EDENAL W
169d35•?607&demh u.cpa609 BUILDING DEPT.
unuur. dhaft>•desahuay. com
The following is required information - an incomplete application will not be accepted. Please print. legibly (in ink) or type.
PROPERTY INFORMATION
SITE ADDRESS __ �C. Cl S � � SUITE/UNIT #
ASSESSOR'S TAR /PARCEL i _ _ - _ _ LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) I S
(Anach epmoe Jbr fap0ty bgaf - .
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING. . ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit onlui cz King Tire & Rescue
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
ed
NAME
'
PRIMARY PHONE
( )
MAILING ADDRESS
CI ,STATE, I
EMAIL ADDRESS
COMPANY NAME 1
ij"
��_�
APPLICANT NAME �j
er
�l�
0
()C11) OS
MAILING ADDRESS
_
CITY, ST TE, ZIP
C LL P NE
CITY OF FEDERAL WAY BUSINESS LICEN3E NUMBER FIXATION ATE
�.- 10 -- �n -r3L-
FAX N MHER
CONTRACTOW 7tn0M*D6 RATIO NU
O TIION DATE
b
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
( ). _
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant []Agent ❑ Other
FAX NUMBER
NAME _ � PRIMAR PHONE - E- MAILADDRESS
NAME
Per RCW 19.2.7.095:
Lender information is required If project value exceeds $5,000
MAILINO ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ $_ oZ0 4Pd5�,
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
PROJECT ••• AREAS
AREA DE9C ON ERISTIN
B0. FT.
BASEMENT
PROPOSED
8 . FT.
TOTAL
FIRST
BUILDING SHELL ONLY?
a YES. a NO
SECOND
a YES
a NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
o YES
ADDITIONAL FLOORS (DESCRIBE)
NEW ADDRESS REQUIRED?
o TES o NO
DECK (O COVERED OR 0 UNCOVERED
a YES.
a NO
PLATTED LOT?
GARAGE [3 CARPORT O
DEMO PERMIT REQUIRED?
a YES
NUMBER OF FLOORS
s�osrvio
rmroesv
TOTAL
Torecsrormosr
TorwLrsoraessst
�,au
**NEW HOMES ONLY".. NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to rem' ain.
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLIC4770NJ
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLEWBING
BATHTUBS for Tub /shower combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAVS Mahroom sw o
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (commerci q
RANGES
REFRIG. SYSTEMS"
URINALS
VACUUM BREAKERS
WATER CLOSETS (ros,q
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cer ft under penalty of perfury that I am the property owner or authorized agent of the property owner. I esrtvy that to the best of my
knowledge, the ir{formation submitted in support of this permit application is true and correct. I cerft that I will comply with all applicable
City of N*deral.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 oumees 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 flied against the city, but only
where such claim arises
yttt of the reliance of the city, including Its o fJieers and employees, upon the accuracy of the information supplied to
the city as a part of tiff! a plieation. ..
SIGNATURE:
a NEW a ADDITION
o ALTERATION
o REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES. a NO
BASIC PLAN?
a YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
a NO
NEW ADDRESS REQUIRED?
o TES o NO
UP /SEPA /8U?
a YES.
a NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
a YES
o NO.
Bulletin it 100 _ August 16, 2007 Page 2 of 4 . lc HandoutsTennit Application .