07-104619•
a
Federal Way .,1T{.(,+,/
COMMUNnY DEVELOPMENT SERVICES 4 *SF MF CO ME EL PL DE EN FP
33325 81H AVENUE SOUTH • PO BOX 9718
FEDEP,L WAY, WA 98 063 -9 718 Ap p L I. C AT I O N To
,253.835- 2607• FAX 253- 835.2609 AUG 2 1
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The following is
Wg> incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS �.} `��-�' �� SUIT /UNIT #
ASSESSOR'S TAX /PARCEL # ^^_q LOT: SIZE (sj?
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)_F &J(3%! -e
(Attach separate page for kngthy legal deaiaiplicn)
TYPE OF -PERMIT ❑ BUILDING b PLUMBING ❑ MECHANICAL `` jj`
❑ DEMOLITION ❑ ELECTRICAL '❑ ENGINEERING I( IRE PREVENTION SYSTEM
PROJECT DESCRIPTION (P�ovide detailed description of work included on this permit onlu) / \\ .
PROJECT NAME (Name of Business or Owner Last Name) T1�1_i
a
PROPERTY NAME PRIMARY PHONE
OWNER W1 nla
MAInNiI. AMIPF.CC. n.mv ogre c n.n c . .... .............
CONTRACTOR
COPY. ev nq d
.1th e e PH t
APPLI
PROJECT
CONTACT
LENDER
OMPANY NAME
_
A NAME
OFFIC P NE
PHONE
;CANT
LI A S
C A, ZIP
C L PH NE
CITY O ED WA
BUSINESS LICENSE UMBER
•
IRAT O A
FAX NUMB`E R
(`
1
lJ�
�/ /� f
`�� - I�JV L.C. Il_
CONTRA OR'S 1ST 1 M R
EXPI T10N DATE
E -MAIL ADDRESS
\
APptfgkNT NAME
I' 1\ J to , 1 ,. I 1l dT l A 1 P1, A l A A. 1 I I ELL PHONE - -
❑ Architect ❑ Tenant ❑ Agent ❑ Other
NAME l PRIMARY PH E E-MAIL ADDRESS
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING USE PROPOSED USE
Tl 1 —L�►�l t . cam_
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? S ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES _,"O
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE 1SEPTIC)
f00Z2cl
i�
4
AREA DESC ION EXISTIN "
S!2, FT
PROPOSED TOTAL
S . FT. S . FT.
BASEMENT
FIRST
ECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (O COVERED OR DUNCOVERED ?)
GARAGE 0 CARPORT ❑
NUMBER OF FLOORS
EEI8TIR0
PROPOSED
�-
TOTAL
TOTAL EMS TWO SP
TDTAL PROPOSED ST
7L7A.
w'NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of f.Udure 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 is —erci4
COMPRESSORS FURNACES RANGES
DUCTS_ GAS LOG SETS REFRIG. SYSTEMS
(PLUMBING ,
BATHTUBS (or Tub /sho Combo) LAVS (sdav m sink.) URINALS MISC (Describe;
DISHWASHERS RAINWATER SYST VACUUM BREAKERS i
DRINKING FOUNTAINS SHOWERS WATER CLOSETS rr a�q
ELECTRIC WATER HEATERS SINKS WASHING MACHINES
HOSE BIBBS SUMPS
SIGNATURE
I certify nder. enai o er that the information furnished b me is true and correct to the best of my knowledge, and further, that I
fy P tiJ .f P .lur'J . .l .� y
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 fiied,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 �"��'`�� -- DATE lS'
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner o Agent ❑ Contractor O Architect ,e-Other pc i et ✓' ` zr.
o IIEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT.
BUILDING SHELL- ONLY? o YES o NO BASIC PLAN? o YES o NO
ZONIIYG DESIGNATION CHANGE OF USE? o YES ONO
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 ONO
r �
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Bulletin #! I DO — January 1, 2007
Page 2 of 4
k \Handouts \Permit Appiication .