07-103657C,ifY OF..`Y' "-."'haw/" C-
rnderal Way �ERMIT:
°COMMUNITY DEVELOPMENTSERVICES MF CO ME EL PL DE E FP
3332JPEDE S L WA SOUTH . 63 971 9710 0 6 2 p p L I C AT I O N
• FEDERAL WAY, WA 98063.9718 77 8 TD
.253. 835.2607• FAX 253-835-2609
"ct, �u-ca ITYAq��O��tF FEDERAL WAY
The following is requi7'ttlltp APUIT4 an incomplete application will not be accepted. Please print legibly (in ink) or type.
ASSESSOR'S TAX /PARCEL # - I LOT: SIZE (so 2 .
i"
LEGAL DESCRIPTION (e.g. Acme Estates, Lot I) fe�,��� p Wix 1' y 13 i dq If.1
(Anach separate page %r lengthy legal dea?iptionl
'• •' •
TYPE OF. PERMIT ❑ BUILDING Q PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING Li FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
PROJECT NAME (Name of Business or Owner Last Name) --- rp'� U I LA11�1
PROPERTY
OWNER
• CONTRACTOR
corn ar e
Wlth each aPp1l;0lan
APPLICANT
PROJECT
CONTACT
LENDER
NAME .i
PRIMARY PHONE
A L G A
C TF„
E —MAIL ADDRESS
COMPANY NAME _
In? I CDC)
PLICANT NAME
o
OFFICE PHONE
—
AILI G D � �
T
CE L ONE-- —
TY FEDERAL WAY BUSE S JCENSE MBER ?( O DA E
F MSER
CONTRACTOR'S RECISTRA14OW14UMBER EXPIRATION DATE
11&b
E- MAILADDRESS
COMPANY NAME
2t
AP CANT NAME
Vj `
OFFICE PHO E
LL ONE
1 1 R r
amRELATIONSHIP
C J ZI)r
T PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
( _
V v .
PRIMARY PHONE
EMAIL ADDRESS
NAME
Per RCW 1927.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE Re- i PROPOSED USE 17 Cd : yl-a Mt7�
EXISTING ASSESSED /APPRAISED VALUE $ 30c) OF PROPOSED WORK $ 4 3Oc�
SPRINKLERED BUILDING? ' O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGH 1NE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
4
11111 i� IIIS 11
,. AREA DESCRIPTITON
F
EXISTING
S ; FT.
PROPOSED TOTAL
S . FT. S . FT.
BASEMENT
g 3
---
�g 3 T
FIRST=
GAS PIPE OUTLETS WOODSTOVES .
BBQS
FANS
ECOND
BOILERS
FIREPLACE INSERTS
HOODS (commercial)
THIRD
FURNACES
RANGES
�!!
DUCTS .
ADDITIONAL FLOORS (DESCRIBE)
REFRIG. SYSTEMS
PLUMBING
DECK (Q COVERED OR 0. UNCOVERED?)
BATHTUBS (or Tub /shows c..w)
LAVS (BMh -. Sinka)
URINALS MISC (Describe;
GARAGE Q CARPORT Q
P
VACUUM BREAKERS
8'3 f
'
NUMBER OF FLOORS
EXISTING
PROPOSED
I TOTAL
TOTAL ZMSrJNG SP
TOTAL PROPOSED SP
TOTAL.
" "NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of facture to be installed or relocated as. part of this project. Do•not include existing fixtures to remain.
MECHANICAL
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
PLUMBING
i
BATHTUBS (or Tub /shows c..w)
LAVS (BMh -. Sinka)
URINALS MISC (Describe;
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS (Tolley
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
r�
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 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 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.
NAME /TITLE L/li
(Signal
RELATIONSHIP TO PROJECT
o NEW o ADDITI,ON
BUILDING SHELL- ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
PLATTED LOT?
A-71 1
❑ Owner ❑ Agent ❑ Contractor
.DATE 7-5--o-7
(Title) ^
o Architect Other A! /M
o ALTERATION o REPAIR o TENANT IMPROVEMENT.
a YES o NO BASIC PLAN? o YES o NO
CHANGE OF USE? o YES ❑ NO
o YES o NO UP /SEPA /SU? o YES o NO
o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin #lO9- .ianuan' 1.200" Page 2 of k\iiandoutAPermit Application .