06-101424moo! ,�.•.
Federal Way
C0JNV) flYDEVELOPMWSERVIC
33325 BTMAVENLB SOLIl7i • PO BOX
FEDERAL WAY, WA 98063 -9718
253 -835 -2607• FAX 253 -835 -2609
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The,jollowbw is reou
RECEIVE
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h"IN&kWA wA ON
BUILDING DEPT
- an incomplete application will not be
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SFMFCOMEELPLDEE
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or
SITE ADDRESS 50,, 9 .� L � C-, SUTEIINT #
ASSESSOR'S TAR /PARCEL # d 6
LOT SIZE (s j)
LEGAL DESCRIPTION (e.g. A-w Estates, Lot 1) ke-> &A-�
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PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL //
O DEMOLITION 13 ELECTRICAL ❑ ENGINEERING &'I IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prop' detailed des tj this on
� a , - „ ,�
PROJECT NAME (Name of Business or Owner Last Name)
C
PROPERTY
CONTRACTOR
NAME
g� G ADDRESS ate' p
COMPANY NAM
CITY. ST TE, ZIP
D'T NAME
OFFICE PHONE
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1 -7I3 ADDRESS �� /�
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City, STATE, ZIP
CELL PHONE
/�.�i(�
( )XYA
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CDY OF FEDERAL WAY BUSINESS LICENSE NUMBER
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EXPIF
- !2 /3( /o[v
FAX NUMBER
(zf251
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CONTRACT DR'S
s L
�
REGISIRAT70N N u
UMBER (copy of card required with each application)
E L
EXPI&4TION DATE
A
'7 / 13
/V&
APPLICANT
COMPANY
APPLICANT NAME
OFFICE PHONE
MAILIlVG ADDRESS
�y�, b . � �
TO
CITY. STATE, ZIP
7� �
[:�V Q iL' t fiJ�
CELL PHONE
-
RELAr NSHIP PROJECT
❑ Architect o Tenant ❑ Agent ther
FAX NUMBER
CONTACT
fI
PRId1ARY
'
E- M�AIgL A S
(4
/DDR�ES
LENDER
PerBCW 19.27.098: Lender irijormation is
NAME
re4uIred {fp %%t value exceeds $5,000
EXISTING USE _ J�` r i [ PROPOSED USE <`�J
EXISTING ASSESSED/APPRAISED VALVE $ VALUE OF PROPOSED WORK
SPRINIMERED BUILDING? ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGIELM ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 13 HIGHI.INE ❑ PRIVATE (SEPTIC)
number of each type of fWture to be instaUed or relocated as part of this protect Do not include existin9_fixlures to remain
Value of Mechanical Work $
SHOWERS
WATER CLOSETS wee MISC (Describe)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS REFRIG. SYSTEMS
BBQS
FANS
HOODS (cow=. ew) WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES MISC (Descri)e)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
ELECTRIC WATER HEATERS
BATHTUBS (orTub/sha c..b°l
SHOWERS
WATER CLOSETS wee MISC (Describe)
DISHWASHERS
SINKS
DRINIUNG FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
CHANGE OF USE?
a YES
a NO
HOSE BIBBS
LAVS akjb �Smxs)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
am I pem+ibj ofperjury that the Wormation furnished by me is true and correct to the best of my knowledge, and further, that I authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless Hof Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
maybe made l person, including the undersigned, and filed against the City of Federal Way, but only cohere such claim
arises out 4f the reliance 4f the ci hiding its gVio— and employees, upon the o the
this application» ac�'OCU f information supplied to the city as a part of
NAME /TITLE
(SIW -t tr) / Mtle) TJ
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent on tractor ❑ Architect ❑ Other
FOIL OFFICE USE ONLY
o NEW , o ADDITION
a ALTERATION
o REPAIR a TENANT IMPROVEMENT
WELDING SHELL ONLY?
o YES ❑ NO
BASIC PLAN?
❑ YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
a YES ONO
UP /SEPA/SU?
a YES
❑ NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED?
o YES
a NO
uuean iiiuu — .January 1, 2UU6 Page 2 of 4 MandoutslPermit Application