08-104712C"T OF
RM IT SF MF CO ME EL PL DE EN -(ED
GDMI M/N/7Y DBVBLOPAOYKI' SSR V1CBS
33325 8m AVEM S SOUTH - PO BOX 9718
PMW-U WAY, WA 98063.9718
253.8353607 -PAX 253.835 -2609 OCT064RPLICATION
tuww.dho&6dera mau.mm 1,702- S W IV 1 ,/ IV1 9
The following mete application will not be accepted. Please print k9ibbj ftn inN or type•
SITE ADDRESS t SUITE /Um # _
ASSESSOR'S TAX/PARCEL # Z 6 2—�, �1 0 - V LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aft -h sqmrft are•h►hWew kod dsvWoq
PROJECT .- •
TYPE OF PERMIT ❑ BUILDING 0 PLUMBING ❑ MECHANICAL
❑ DEMOLITION O ELECTRICAL ❑ ENGINEERING AFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this ner►nit onlui
we-
PROJECT NAME (Name of Business or Owner Last Name) l t► Vc -iC'i'
PEOPLE INFORMATION
•"
�/ N i f MV, % 06, ym
OFFICE PHONE
TOVOY\ CY'i
PHONE
(Zt5')
CONTRACTOR
APPLICANT
LENDER
COMPANY NAME
CANT NAME
OFFICE PHONE
TOVOY\ CY'i
PHONE
(Zt5')
MARINO ADD RE33
CrrY, STATE, ZIP
CELL PHONE
11
Y t% q &M—
O Architect O Tenant O Agent O Other
cm OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRA ON/D�ATTEE
FAX NUMBER
Z'-
- ,V O
�i
( b
R'S REGISTRATION NUIUMR
EXPIRATION DATE,
E MAR. ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
CrrY. STATE, ZIP
PHONE
MAR INO ADDRE33
Crff, STATE. ZIP
CELL PHONE
-
RELATIONSHIP TO PROJECT
FAX NUMBER
O Architect O Tenant O Agent O Other
NAME
Per RCW 19.27.095.-
Lender igjonnaden is regzdred if project mdue exceeds ;6,000
MAUJNO ADDRESS
CrrY. STATE, ZIP
PHONE
EXISTING USE 1�1 PROPOSED USE 4LI 1
MaSTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED RUILDINO? YES ONO FIRE, SUPPRESSION SYSTEM PROPOSED /REQUIRED? O YES ONO
WATER SERVICE PROVIDER a �LAKEHAVEN O HIOHLINE 0 TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER 13 LAKEHAVEN O HIOHLINE O PRIVATE (SEPTIC)
is I
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
SQ. FT.
TOTAL
S . FT.
BASEMENT
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
FIRST
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (romp
SECOND
SINKS
WASHING MACHINES.
HOSE BIBBS
THIRD
-o YES o NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT?
o YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
a YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
msmro
PROPOSED
TOUL
IWALsmrmwer
Toru.rsaroesosr
mreasr
•'NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fucture to be installed or relocated as part of this project. Do not include existing fudures to remain.
A13129"CAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATIOM
_ AIR HANDLING UNITS EVAPORATIVE COOLERS OAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOOD3lco®madp
_ COMPRESSORS FURNACES RANGES
DUCTS. GAS LOO SETS REFRIG. SYSTEMS
Z Cato under penalty of pwjwg that I am the property owner or authorised agent of the property owner. I coWfy that to the best of my
knowledge, the h formation submitted in support of this permit application is true and correct. I cerft that 1 will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the tesuance of this permit
does not remew the owner's 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, ezpenass, and attorneys' fees incurred in the
investigation and defense of such cla W, which may be made by any person, inchuting the underWgn*4 and filed against the city, but only
where such claim arises out of the reliant* of the city, including its officers and empiogees, upon the accuracy of the information supplied to
the city as a part of this application.
SIGNATURE: _
Owner and /or
DATE 10 .3' O 6
o NEW o ADDITION
a ALTERATION
a REPAIR a• TENANT IMPROVEMENT
BATHTUBS (e Tab /sue c=
LAVS ( Mni*
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (romp
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES.
HOSE BIBBS
SUMPS
-o YES o NO
Z Cato under penalty of pwjwg that I am the property owner or authorised agent of the property owner. I coWfy that to the best of my
knowledge, the h formation submitted in support of this permit application is true and correct. I cerft that 1 will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the tesuance of this permit
does not remew the owner's 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, ezpenass, and attorneys' fees incurred in the
investigation and defense of such cla W, which may be made by any person, inchuting the underWgn*4 and filed against the city, but only
where such claim arises out of the reliant* of the city, including its officers and empiogees, upon the accuracy of the information supplied to
the city as a part of this application.
SIGNATURE: _
Owner and /or
DATE 10 .3' O 6
o NEW o ADDITION
a ALTERATION
a REPAIR a• TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN?
o.YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
o NO
NEW ADDRESS REQUIRED?
-o YES o NO
UP /SEPA /SU?
o YES
a NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 — January 1, 2008 Page 2 of 4 MandoutAPermit Application