05-106369ary OF
Federal Way RECEIVE? PERMIT
COMMUNITY DEVELOPMENT SERVICES
33325 SOUTH • BOX 97
FEDERAL WA Y, WA 98063 -9718 b E C 1 5 2
25-835 -2607• FAX 253- 835 -2609
APPLICATION
uauio citiloffederalwau.com
CITY OF FEDERAL WAY
SITE ADDRESS 5J00-6-'
S
ASSESSOR'S TAX /PARCEL # -L 0 - 1 1 O - u 1 - C1 0 9 0 LOT SIZE (sp
SF MF CO ME EL PL DE EN
SUITE /UNIT #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for tengthy Legal description)
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL )
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING C/ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
TAskc„l1 NFPA 13 F;rr- S Vc;^ ckr SwLSk A
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
SS
NAME V p U S N(
v fW C`
T
APPLICANT NAME
`BINARY PHONE
NZ15) 453
-4100
MAILING ADDRESS
`71S 11$ Avc S E She. 300
CITY, STATE, ZIP
13e llcvue
U A Cl$00S
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
COMPANY NAME
PG'}'c.o� Flot %kA'-6A
APPLICANT NAME
Z� F7arA
OFFICE PHONE
(ZS3 ) 426
-?290
MAILING ADDRESS
CITY, STATE, ZIP
❑ Agent ❑ Other (Describe)
CELL PHONE
? Ol 10 Ave. r-
T�.Lo WA
994Z4
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
1 9 _9 t - 1 O 1 `) �3 b -
EXPIRATION DATE
/ /
FAX NUMBER
(ZSS) 9ZL
-6)50
_ B
L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application) EXPIRATION
DATE
P A T K I T 0"1 9 L
COMPANY N
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant
❑ Agent ❑ Other (Describe)
( ) -
EXISTING ASSESSED /APPRAISED VALUE $
PROPOSED USE
FA('zsS Cen�v
VALUE OF PROPOSED WORK $51 v O
SPRIN1=RED BUILDING? 4/YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REgUIR.ED? ❑ YES ❑ NO
WATER SERVICE PROVIDER AAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
• i
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
89. FT.
BASEMENT
EVAPORATIVE COOLERS
BBQS
FANS
FIRST
FIREPLACE INSERTS
COMPRESSORS
FURNACES
SECOND
GAS PIPE OUTLETS
NEW ADDRESS REQUIRED?
o YES , ❑ NO
THIRD
UP /SEFA /SU? o YES
o NO
PLATTED LOT?
FOURTH
DEMO PERMIT REQUIRED? ❑,YES
o NO ,
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
RXMMG
a`vPOSED
Tornc
TOTAL ZMT11gci eF
TOTAL MOPO sn OF
Ao1At 8b
"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.
MECHANICAL
SHOWERS
Value of Mechanical Work $
SINKS
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
GAS PIPE OUTLETS
BATHTUBS (or Tub /Shower Combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Bathroom Sinks)
VACUUM BREAKERS
GAS LOGS
HOODS (Commerciai)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toilet)
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTIOC WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cert(fy 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 f led 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. �` t �� Q (fin
NAME /TITLE :' o � "' �� 1 CO 1PG� (' 1Gf�l�Ul� C DATE
(Signature) ('title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑ Other
o NEW ❑'ADDITION
o ALTERATION
o REPAIR ❑ TENANT IMPROVEMENT
BUILDING SBZLL`ONLY? >
❑ YES o NO
BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES , ❑ NO
UP /SEFA /SU? o YES
o NO
PLATTED LOT?
❑ YES o NO
DEMO PERMIT REQUIRED? ❑,YES
o NO ,
Bulletin #100 - January 7, 2005 Page 2 of 4 k\Handouts\Permit Application