05-101100�3
CITY Of
Federal Way
, 0
Y PERMff SF MF CO ME EL PL DE E P [D COMMUNITYDEVELOPMENTSERVICES AL WAY
33325 8TH AVENUE SOUTH • PO BOX 9718 j
FEDERAL WAY, WA 98063 -97] 8 A P P L I C L► REPT,
253- 835 -2607• FAX 253 - 835 -2609
wurcu. cifuor'f deratwau. cam
The followina is reauired information - an incom lete a lication will not be acegi2ted. Please print beqibIN in ink or tyRe.
p PROPERTY •- •
SITE ADDRESS 33 1 5} �� SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # _ - LOT SIZE (s,/)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
!Attach separate page for lengthy legal description/
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION 4 ELECTRICAL ❑ ENGINEERING KFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlU1
I r',s ed is L� UV� elf - 'XR r--,oa pee,M , Y-ewaac akwa v ja+0r., ? S mD t4.Q - of e, ¢ C4-yys
4 "- 444 c.,cx.P gull Sia.+Msv 9 I Lu6 Q-r a s . LL S+v-zlb ,Es: , 1 ;2, ",-x-
PROJECT NAME (Name of Business or Owner Last Name) �lel p U— XA.3 L-5� D R C_e— yLA"1
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
NAMO ` , w�
U
PRIMARY PHONE
MAILING ADDRESS
2v Joe; Al-e NC`1
CITY, STATE, ZIP
tle vl.4e WA g 8004
COMPANY NAME
+N Q—c yi Alarm, Inc/
APPLICANT NAME
MajF Jae lIc)
OFFICE PHONE
(zo w 3ZB - 32��
MAILING ADDRESS
125 3 S • �c+�,1✓s� t
CITY, STATE, ZIP
S��-t U W A �i q4-
CELL PHONF
( 20;6) Sol 1 - 20 g
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
— — — — — — — — — — B L / /
FAX NUMBER ER
(1vo) 9j7"2, - 721
CONTRACTORS REGISTRATION NUMBER (copy I card required with each application) EXPIRATION DATE
W A S !i A 2. B 2 G 3 12-/ 5/ IDS
Y YPl/w7• r` E / Vr" nL
�jN
AMa TI -Lf 1
OFFICE
2
J7) 3 2(J ✓ 0 3
MAILING ADDRES
I?-� 3 S JaP•k saw S�- .
CITY, STATE, ZIP
S_eCt _� 31 4-y-
CELL PHONE
( - I -2019
RELATIONSHIP TO PROJECT _ _,
❑ Architect ❑ Tenant ❑ Agent Other (Describe) 61C+Vxy'
FAX NUMBER
(Zo(v) 322 -`7 1-
N KA" to
PRIMARY PHONE - ��
E -MAIL ADDRESS
Per RCW 19:27.095. binder information is
required if project value exceeds $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING USE PROPOSED USE
��a�%�.
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK i$ _
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/ REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN 11 HIGHLINE ❑ PRIVATE (SEPTIC)
� f
0
0
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
o REPAIR ❑ TENANT IMPROVEMENT
BUILDING $$ELL ONLY? c YES o NO
FIRST
BASIC PLAN?
a YES
❑ NO
SECOND
CHANGE OF USE?
❑ YES
THIRD
NEW ADDRESS REQUIRED? a "YES a NO
UP /SEPA /SU?
FOURTH
❑ NO
FLATTED LOT? n YES a NO
ADDITIONAL FLOORS (DESCRIBE)
ti YES
❑ NO
DECK(COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�
raorosao
TOTAL
roTAIMM "
Toru.m sr oros=
TOTAL"
"NEWHOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
type of fixture to be installed or relocated as part of this project. Do not
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
PLUMBING
BATHTUBS J- Tub1Sb—C.mbo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAYS (Batbmom Sinks)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toilet) _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including its officers and employees, upon the accuracy of the information supplied to the city as a part of
this application.
NAME(TITLE, � { A,:Aky iP-i DATE 3 to r�
( ature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑Xgent ❑ Contractor ❑ Architect ❑ Other
Bulletin #100 —January 7, 2005
Page 2of4
k\Handouts\Permit Application
a NEW o ADDITION a ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT
BUILDING $$ELL ONLY? c YES o NO
BASIC PLAN?
a YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED? a "YES a NO
UP /SEPA /SU?
o YES
❑ NO
FLATTED LOT? n YES a NO
DEMO PERMIT REQUIRED?
ti YES
❑ NO
Bulletin #100 —January 7, 2005
Page 2of4
k\Handouts\Permit Application