07-105138RECEWL L La -3
Federal way S E P PERMIT
COMMUN11Y DEVEWPMEW SERVICES 2O0J SF MF CO ME EL PL DE EIS
3332 ED•AVENUE SOUTH • PO BOX 9718
E pLI CATI O N
FEDERAL WAY, X 'I FFLOERAL /
253 -E35 -2607• FAX 25 5 -
wuu.cmjoffedera1u,ay.co IWING DEPT,
The following is required ir(formation - an incomplete application will not be 1. Please print legiblg (in
PROPERTY •. •
SITE ADDRESS 3 y 5cI So,f k •,,3� -I ti fib` C..k.& / surrE /umT # G14 0
ASSESSOR'S TAX/PARCEL A Q a a -L O , -- - .�C? -0- -Cm LOT SIZE (sl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(4' APO n s k.90 J Lea a ..VH.V
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING Q MECHANICAL
❑ DEMOLITION 0 ELECTRICAL 11 ENGINEERING C+ f= PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description off work included on this hermit ontul 1
T.TJ 1i F�.rr� n l rl iirr T4A n '5.- "e.,rY e c 4-+ reI C=j C 4p.n d
re a
z_ Jk ee In c;�cwrl-
4. G 0 ✓'Le, c Q 15�11c,
c4 r�"3 (-j I1\ ferha,; ^.
PROJECT NAME (Name of Business or Owner Last ( n n.
PROPERTY
OWNER
CONTRACTOR
PROJECT
CONTACT
LENDER
EXISTING USE
PEOPLE INFORMATION
NAME
L n j
PRIMARY PHONE
(aS3 ) an— - a )�
MAEINGADDRESS
p o 9,71 <a
O STATE. ZB'
l iE
E-MAIL ADDRESS
E- MAADDRESS
COMPANY NAME
to ir 4 m
APPLICANT NAME
r Lebmc r\
OFFICE
PHONE
(553 )6a 7 J ?Clq
MvD
341 S S. .\tk S
CRY, STATE. ZIP
a, � 9$`id5-
CELL PHONE
( )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER TION DATE
FAX NUMBER
( 853)Ga,7
CONTRACTOR'S REGISTRATION FOIBER H%PIRATION DATE
Ev KG A goo
E-MAIL ADDRESS
I aLehwia
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CRY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT I
O Architect O Tenant D Agent Either a GL ►k
FAX NUMBER
( ) -
PRIMARY PHONE E -MAR. DRESS
S C� cc.r% (dS ) 6a - ` i -ire
NAME
Per RCW 19.27.095:
Lender irUlmmaNnn Is required (f prgka Data.¢ exceeds $5,000
MARLING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? D YES D NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? D YES ❑ NO
WATER SERVICE PROVIDER D LAKEHAVEN D HIGSLDiE O TACOMA D PRIVATE (WELL)
SEWER SERVICE PROVIDER D LAKEELAVEN D HIGHLINE D PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
SQ.
PROPOSED
SQ. FT.
TOTAL
SQ.FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND S L4 Q
GAS LOG SETS
REFRIG. SYSTEMS
=RD
❑ NO
NEW ADDRESS REQUIRED? :)YES ❑ NO
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT? ❑ YES ❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
s�ruw
vsoroe�
rme�,
rornr.smnroa
rorwcrnwae ®a
roreca
•'NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of jiMure to be installed or relocated as part of this project. Do not include existing j)xtures to remain.
of Mechanical Work
(A COPY OF BID OR ES71MAIE MUST BE INCLUDED WrM APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS [cowoecds0
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS [ml b /slw combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
IAVS (eat . st m)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS Iroileo
SINKS
WASHING MACHINES
SUMPS
❑ YES a NO
I certjjy under penalty of perjury that I am the property oumer or authorized agent of the property owner. I certWu that to the best of my
knowledge, the bijor oration submitted in support of this permit application is true and correct. I certVy that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorized 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 casts, expenses, and attorneys' fees incurred in the
investigation and defense of such claim), which may be made by any person, including the undersigned. and Jiled against the city, but only
where such claim arises out of the reliance of the city, including its q icers and employees. upon the accuracy of the iybrmation supplied to
the city as apart of his /gip /glicatinan.
SIGNATURE: ( /�vr Cow O� _ DATE O O
�°' .i.. fhvnPr anri /n Anthnrirrd Agent
rmavr= USE 01ILY
a NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES a NO
BASIC PLAN? a YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? a YES
❑ NO
NEW ADDRESS REQUIRED? :)YES ❑ NO
UP /SEPA/SU? c YES
a NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED? a YES
❑ NO
Bulletin #100 — August 16, 2007 Page 2 of 4 k\J4andoutslPermit Application