05-105913' CITY or
Federal Way
COMMUNITY DEVELOPMENT SERVICES
33325 8- AVENUE SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063.9718
253- 835 -2607• FAX 253- 835 -2609
u� ww. cituoRederalwa u. cem
The followina is
11
DECEIVE ®dS p
PERMIT a ® ®� SF MF CO ME EL PL DE E FP
APPLI CAT'eoTD
DERA L W ly
BUILDING DEPT.
!on - an incomplete application will not be accepted. Please print leaibW tin inkl or tope.
SITE ADDRESS 2255q 15 I 'T Vf " '!�DUN
ASSESSOR'S TAX /PARCEL #
SUITE /UNIT # / 0 0
LOT SIZE (sf)
LEGAL DESCRIPTION (e. g. Acme Estates, Lot 1) k m RU 0 " 0 W-Lt 1bI U 11 q 1 !1�'
(Attach separate page for lengthy legal descriphan)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING MECHANICAL
❑ DEMOLITION e7►L ❑ ENGINEERIN RE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
PROJECT NAME (Name of Business or Owner Last Name) N VA 911 IFS' O Tl I� �V i� 4� W �v
� v
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
L5 i6�c WA Y
,STATE, ZIP I 533
: -
K;.0F,RA 1,wr-4 Y, WA • qpcv-
COMPANY NAME
APPLICANT NAME
MCL [ltd
OFFICE PHONE
(fib
APPLICANT NAME
OFFICE PHONE
CELL PHONE
W (511
r 14106, n
( l -
W4� rtLlt
FAX NUMBER
i,b )X22 - '?"
MAILING ADDRSFS
i253 5
(Td Cizo," ST
CITY. STATE, ZIP
Sru , W* aa%4
CELL PHONE
c 0-cy, ) 39 1
- Zo 1
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
?A*
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application)
EXPIRATION DATE
W kC,,- R—
-1 A z 2 g 2.
L3
COMPANY NAME
0114 -RI
APPLICANT NAME
MCL [ltd
OFFICE PHONE
(fib
MAILING ADD S
CITY, STATE, ZIP
CELL PHONE
Z5 3 5 T It LI S T
SCQ �IVr a
( l -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent M ther (Describe) W Yl
FAX NUMBER
i,b )X22 - '?"
NAME PRIMARY PHONE E-MAIL ADDRESS
,. Per RQ- rt$1.i %Q9$S `rtiK�eril�Af'fflatiOn is ..
r"Uirmf ( ir"cif ¢t•walue exceed+ *8,000 . ,
NAME
MAILING ADDRESS
CITY, STATE, ZIP
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ I I • -M VALUE OF PROPOSED WORK $
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)
Y j '
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
9Q. FT.
TOTAL
S . FT.
BASEMENT
ZONING DESIGNATION
CHANGE OF USE?
FIRST
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
SECOND
FANS
HOODS (c— w)
WOODSTOVES
THIRD
FIREPLACE INSERTS
RANGES
MISC (Describe)
FOURTH
FURNACES
GAS WATER HEATERS
ADDITIONAL FLOORS (DESCRIBE)
GAS PIPE OUTLETS
DECK (COVERED ?)
GARAGE ❑ CARPORT ❑
SHOWERS
WATER CLOSETS rroaeq
MISC (Describe)
NUMBER OF FLOORS
ma"110
rsoroea
TOT"
mtsregsrntgar
�orAC'gtoresmsr.'
mru,se ,
'•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
MECIiAMCAL
Value of Mechanical Work $
ZONING DESIGNATION
CHANGE OF USE?
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (c— w)
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
COMPRESSORS
FURNACES
GAS WATER HEATERS
DUCTS
GAS PIPE OUTLETS
PLUMBING
BATHTUBS (or Tub /Shower combo(
SHOWERS
WATER CLOSETS rroaeq
MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYST
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bathroom Sinks)
VACUUM BREAKERS
ELECTRIC WATER HEATERS
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 authorised 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. n j L /T
NAME /TITLE V U C� //{{(� )All �1A '1 / V S
(Signature( (Title(
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent VV ntractor ❑ Architect ❑ Other
Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Pennit Application
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? ❑,YES o NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
- o NO
Bulletin #100 — January 7, 2005 Page 2 of 4 k\Handouts\Pennit Application