08-101700cC�myy,,,,af CEIV E SL � SC L �� O
Fe
COMMUNITY DBVBLDPAlBNT 3
9 2008 P E R M IT SF MF CO ME EL PL DE E FP
33345 8r" 5.260 B SOUTH. X 7 GYP L I C AT I O N
WW,Q FBDBRAL WAY, WA 98063.9718
459435 -4607• FAX 453435 -2609
FEDERA
The following is requig�*brmation -an incomplete application will not be accepted. Please print legibly (in ink) or type.
SUITE /UNIT t
ASSESSOR'S TAX /PARCEL # -0.5— _F_ Y 2.0- O / (� Q LOT SIZE (sf
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Z/C
(A�Od ` +•, -ruts Papelbr I.Wft ► soot dsa.Od.N
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCF1PTION /Provide detailed description of work included on
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
NAME
(M&) ONE
PRIMARY PHON
OWNER
O
y
RELATIONSHIP t TO PROJECT Agent
Architect Other
(ZS ) �-
-
MAILING XDDRZSS
CITY, STATE, ZIP
FAX NUMBER
c �► �1y —b35
E-MAIL ADDRESS
E-MAIL)
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY N� � �
APPLICANT NAME
(M&) ONE
MAILING ADD �
, E,
CELL PHONE
y
RELATIONSHIP t TO PROJECT Agent
Architect Other
�
-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
-
TION DATE
-
FAX NUMBER
c �► �1y —b35
E-MAIL ADDRESS
CONTRACTOR'S RFAMR&TION NUMBER =IRATIUA DATE
COMPANY NA4
�\
APPLICANT N�ME
OFFICE PHONE - 0�245r
MAILING ADDRESS
•
CELL PHONE -
TE,
I <K�
y
RELATIONSHIP t TO PROJECT Agent
Architect Other
NUMBER 4��
1
❑ ❑Tenant ❑ PL�.�AG_
NAME � , PRIMARY PHONE - z E MAA.ADDRE93 J
NAME
Per RCW 19.27.095:
Lender Jgrormation is required (f project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK $ .5 S�
SPRINKLERED BUILDING? ❑ YES 1W NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? DES ❑ NO
WATER SERVIC)t PROVIDER 0 HAVEN ❑ HIGHLINE ❑ TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER ZLAK EHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC(
AREA DESCRIPTION
EXISTING
8 . FT.
PROPOS
S
TOTAL
SO. FT.
BASEMENT
WATER CLOSETS tromp
SINKS
WASHING MACHINES .
FIRST
o NO
ZONING DESIGNATION
SECOND
CHANGE OF USE?
a YES
o NO
THIRD
'
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
r
o NO
PLATTED LOT?
a YES a NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
o YES
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
"tOTO°iD
TOTAL
roan sxrsaso ar
rorec morosas sr
rorec sr
"NEW HOMES ONLY*" ER 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
eaaaaaspea.�ru+ .
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS.
BATHTUBS (or Tub /ah.Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
GAS PIPE
GAS WET
-- KUU1Jd (c0=M dq
RANGES '
REFRIG. SYSTEMS
LA) m sk*o
URINALS
NWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS tromp
SINKS
WASHING MACHINES .
SUMPS
o NO
WOODSTOVES
MISC (Describe)
MISC (Describe)
I cer ft under penalig of peyury that t am the property owner or authorised agent 4f the property owner. I cert{jy that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I cert{fy that I 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 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 4f such elaW, which may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out of thes+eliance of the city, inchuling its o lcers and employees, upon the accuracy of the information supplied to
the city as apart of this appliongetE _
SIGNATURE: I/�i�p' DATE
Probft Owner and /or Authorized Agent
NEW a ADDITION
a ALTERATION
a REPAIR o, TENANT IMPROVEMENT
B�MDING WELL ONLY?
a YES a NO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
o NO
NEW ADDRESS REQUIRED?
a YES a NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
a YES a NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #100 — January 1, 2008
Page 2 of 4
k\Handouts\Permit Application