07-101640t
RECEIVED
CITY
Federal Way PERMIT
COMMUNITY DEVELOPMENT SER
v"R 2 9 2007 SF MF CO ME EL PL DE EN FP
33325 AVENUE SOUTH • PO BOX 9718 D p L I C ATI O N
FEDERAL WAY, WA 980�q63 -9718�q /�
253- 835- 2607• FAX 253- OfTY9VF FEDERAL
www cit9ot(ederglwau.compDILDING DEPT.
The following is required information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS 3 W l -1 raC C.4w r-cd SUITE /UNIT #
ASSESSOR'S TAX /PARCEL #
_ LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page jm lengthy Ie9al descdptloN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
n F p7r 7 -cam 7T) r rnC
PROJECT NAME (Name of Business or Owner Last Name) U�S �1'L.0
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
COPY of card required
with each application �—✓
'�PPLICANT
l
�1
PROCT
CON (CT
LENDI�R
USE
NAME
DNS U) ULC,
PRIMARY PHONE
(qS ) ,f -3 - 4) oo
MAILING ADDRESS
S � SU cT M
CITY, STATE, ZIP
�.CE £Jc� E t,�n4 SUDS
E -MAIL ADDRESS
COMPANY NAME 1
f
APPLICANT NAME
61bTMA4
APPLICANT NAME
EGK
OFFICE PHONE
(Zcb l7$iC -3£i06
/�Acrf'tG iCcrtC - cva,L
Crtc.
%iv1AlJ
FAX NUMBER
(Z-66 ) 716 - 91 (00
MAILING ADDREESS� p ,�,y `
157 Yv �.� Q� rF -
,�, ,
, M
CITY, STATE, ZIP �y¢ �!`,
S'L -/kT7l t.✓JQ' [C� /T T
CELL PHONE
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
v�- •u34��G 2 - 3 l r n--7
tW(, ) 7Z6
CONTRACTOR'S REGISTRATION NUMBER
PXlGS 0f73
EXPI TIO DATE
/d3o07
E -MAIL ADDRESS
` PLA
-)ine(?� prs. t37-
COMPANY NAME c
FAc -F� �
APPLICANT NAME
61bTMA4
OFFICE PHONE
(Z ')C-) 79f -38'06
MAILING ADDRESS
IM el)A.A42
CITY, STATE, ZIP
t z wR 17VOY
CELL PHONE
( ) -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other ��'T
FAX NUMBER
(Z-66 ) 716 - 91 (00
NAME PRIMARY PHONE E -MAIL ADDRESS
Ti PA JeA�5Fr4 A,J (zo(, ) 7 88 - 380(o 1.1aee PFS , (S 12
NAME
Per RCW 19.27.095:
Lender if{formation is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE MM
ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ W
SPRINK¢XRED BUILDING?
WATER) SERVICE PROVIDER
SEWER, SERVICE PROVIDER
❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
• LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
• LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
EML 41 149
PROPOSED TOTAL
SQ. FT. I SQ. FT.
BASEMENT
FIRST
SECOND
r� .4-M
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR El UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS Wllli fa I MOPDSSD TOTAL I TDTAL EnIM11 SF I IVIAL P"O"OH SF TDTAL Sr
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type ofjixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (Commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (o TUb /Shower Combo)
LAVS (Bathroom Sinks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (r.00
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
❑ YES
I cert(fy under penalty of perjury
am authorized by the owner of the c
harmless tVCity Wayde � �
such claimm b arises out i �j this applic c/
RELATIONSHIP TO
nformation furnished by me is true and correct to the best of my knowledge, and further, that I
tises to perform the work for which the permit application is made. I further agree to hold
Lim (including costs, expenses, and attorneys' fees incurred in the investigation and defense of
including the undersigned, and filed against the City of Federal Way, but only where such claim
egof'icers and employees, upon the accuracy of the information supplied to the city as a part of
❑ Agent ❑ Contractor ❑ Architect ❑ Other.
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUIIAING SHELL ONLY?
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO `
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REQUIRED?
❑ YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
t
f
Bulletin #100 - January 1, 2007 Page 2 of 4 k\Handouts\Permit ApplWation
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