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06-106465
Federal Wa pEC 2 7.2006 a &- 10- Y PERMIT SF MF CO ME EL (0- PL DE EN P COMMUNM DEVELOPMENT SERVICES 33325 D AVENUE SOUTH • 63 BOX 97P'TY I F NAV L T C A T I O N FEDERAL WAY, WA 98063 -9718 TD 253- 835- 2607• FAX 253- 835.2609 BUILDIN www.d Wffederalwati om The following is required information -an incomplete application will not be accepted. Please print legibly (in ink) or. type. PROPERTY • • SITE ADDRESS �� J 1a , ✓Cl (' 1Af,'L� Q SUITE /UNIT # ASSESSOR'S TAX /PARCEL # ✓ - Q V LOT SIZE (sj LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Attach separate page /or lengthy legal description) PROJECT / • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL .❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING IRE PREVENTION SYSTEM PROJECT DESCRIPTION /Provide detailed description of work included on this nermit on1u1 PROJECT NAME (Name of Business or Owner Last Name) PROPERTY: OWNER CONTRACTOR COPY of a-4 regWred with dieh Ppli."n APPLICANT . PROJECT CONTACT LENDER l c NAME v� O PRIMARY PHONE - MAILING ADDR SS STATE, ZIP E-MAIL ADDRESS COMPANY N E ` AP LICANT OFFICE PHONE c' � r EME (� ©rd `I 3 MAILING ADDRESS ^ RTAT ZIP _ �? lit2 Pf3,�°"' � C-L i^1 :`?! e, S . G_.L'k /t_ � G4*1 G?(3 l ifs' Z. ^" " -" ENE mil' FAX NUMBER i x vi e&IjEI.nt, WAY USIN6ss LICENSE NUMBER E)PIRKFIUI4 I. its o, -ion -1 - ,a -fir, CONTRACTORS REGISTRATION NUMBER EXPIRATION DATE E -MAIL ADDRESS. COMPANY NAM APPLICANT NAME OFFICE PHONE MAILING ADDRESS CITY, STATE, ZIP CELL PHONE RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent ❑ Other FAX NUMBER ( - NAl PRIMARY PHONE - E -MAIL ADDRESS Y' I r NAME Per RCW 19.27. 095: Lender irVormation is required (f project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP PHONE EXISTING USE PROPOSED USE EXISTING ASSESSED /APPRAISED VALUE $ 'VALUE OF PROPOSED WORK SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE.SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑•YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER 11 LAKEHAVEN . ❑ HIGHLINE ❑ PRIVATE (SEPTIC) PROJECT ••• AREAS AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. _. TOTAL S . FT. BASEMENT FANS GAS WATER HEATERS MISC (Describe) BOILERS FIRST HOODS pommemiai) COMPRESSORS FURNACES SECOND DUCTS GAS LOG SETS REFRIG. SYSTEMS THIRD NEW ADDRESS REQUIRED? o YES o NO ADDITIONAL FLOORS (DESCRIBE) o YES o NO PLATTED LOT? DECK (❑ COVERED OR ❑ UNCOVERED ?) DEMO PERMIT REQUIRED? o YES GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS ewsT.rra eROeosen TOTAL TOTAL ausrrrm Sr TOTAL rROP08eD 8r TOTAL 8r "NEWHOMES 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 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 pommemiai) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG. SYSTEMS PLUMBING BATHTUBS (or Tub /show rCombo) DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS LAVS (Bathroom Sinks) URINALS MISC (Describe) RAINWATER SYST VACUUM BREAKERS SHOWERS WATER CLOSETS (roneq SINKS WASHING MACHINES SUMPS o NO 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 office and employees, upon the accuracy of the information supplied to the city as apart of this application. NAME /TITLE r DATE ig t ) e) RELATIONSHIP TO PROD o O r o Agent Contractor o Architect o Othet o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? o YES ONO BASIC PLAN? o YES o NO ZONING DESIGNATION CHANGE OF USE? o YES o NO NEW ADDRESS REQUIRED? o YES o NO UP /SEPA /SU? o YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin # 100 — January i, 2006 Page 2 of 4 k%Handouts\Pennit Application