08-103605RECEIVED 0 3
Federal way JUL 3 0 20003 PERMIT
COMMUNfrYDEVEL40PMEW SERVICES SF 1VfF CO ME EL PL DE EN
®
333258a{AVENUESO X9711E FEDEAPRA (CATION
FEDERAL WAY, W 18�
253 -835 -2607• FAX 5- 60
www.cltuo((ederalwau.com CDS
TheJolioluing is required tt}jormntion - an incomplete application until not be accepted. Please print legibly (in ink or type.
PROPERTY • •
SITE ADDRESS LO 18 S �=-�►1 rvlo/�S ID ^^�� SUITE /UNIT #
T
ASSESSOR'S TAX/PARCEL # �� � � `(� � O � _ LO SIZE ( s fi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Aaach -p-aL- p .WIa L-m6W L-9W de —VdoN
PROJECT • •
TYPE OF PERMIT ❑ BUHMING ❑ PLUMBING ❑ MECHANICAL �/1
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING CAI FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work —hided on this permit onlu)
p A AJ
PROJECT NAME (Name of Business or Oumer Last Na w) 1.
PROPERTY
OWNER
CONTRACTOR
APPLICANT
Jk
PROJECT
CONTACT
LENDER
NAME
^•
PRIMARY PHONE
MAIL 5.Lm. '31
nY, STATE, ZT C
E -MAIL ADDRESS
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
- 7- 0 -(='`}- )(":> (0�loS -c)0 - 1Z -31-OS
FAX NUMBER
t ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
501( Ps--+PZ [27i- VYN Q> C2 -3 t —cog
CO ANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
o�� ��
CITY, STATE, ZIP
aI 6p4wwv
CELL PHONE
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
- 7- 0 -(='`}- )(":> (0�loS -c)0 - 1Z -31-OS
FAX NUMBER
t ) -
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
501( Ps--+PZ [27i- VYN Q> C2 -3 t —cog
E -MAIL ADDRESS
COMPANY NAME ,^
V-z 1 �%�'��� ✓M�Ci
4
APPLICANT
AWE
OFFICE PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
( ) -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
NAME
PRIMARY PHONE
E -MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender irtformation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ f yo
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ MGHL[NE ❑ PRIVATE (SEPTIC)
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
FT.
TOTAL
SQ. FT.
BASEMENT
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
FIRST
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
SECOND
SUMPS
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
2°°O
PROP"®®
ranv
Tuxac s�uc sr
Tmw[ rxoraem sr
�rec ar
"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 remain.
Value of Mechanical Work $ (A COPY OF BID OR ESTAfATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS WSC (Describe)
BOILERS FIREPLACE INSERTS HOODS )commecdlal)
COMPRESSORS FURNACES RANGES
DUCTS _ GAS LOG SETS REFRIG. SYSTEMS
BATHTUBS for lbb /Shower combo)
IAVS )Bathroom Sv s)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS ( lie)
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I certify under penalty of perjury that I am the property owner or authorized agent of the property oumer. I eerift that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify that I uAli comply with all applicable
City of Federal 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 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, 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, 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 apart of this applipation. /f
SIGNATURE:
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS
PLATTED LOT?
Bulletin #100 —August 16, 2007
ff
Owner and /or Authorized
❑ ALTERATION
❑ YES ❑ NO
❑ YES ONO
❑ YES o NO
_7 _L = 9
❑ REPAIR o TENANT IMPROVEMENT
BASIC PLAN? ❑ YES ❑ NO
CHANGE OF USE? ❑ YES ❑ NO
Page 2 of 4
UP /SEPA/SU?
DEMO PERMIT
• YES o NO
• YES ❑ NO
MandoutsTermit Application