07-105531Federal Wa �T 0
Y O EL PL DE FP
COMMUNITY DEVELOPMENT SERVICES S PERMIT SF MF C
33325 BTMAVENUE 5011TH • PO BgWfcy� OF FEDE pfPLICATION
253-835-2607- AX253- 835- 266009►t ,BUILDING D
wwu clttloffederu1wau.com
The following is required iq ormation - an incomplete application will not be accepted. Please print legibly Cn ink) or type.
}. PROPERTY INFORMATION
SITE ADDRESS 14 3 5 3 4 B th St , (�1 SUITE /UNIT # i D + n
ASSESSOR'S TAR /PARCEL # 8 _J_ •2 _l 5 - 0 D � O LOT SIZE (sl 3 �, 6D.2.
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) C ro cs i n a Retail Cent Cr Bs P
(Attach separate page] r , lhy legal d—r (WOW
TYPE OF PERMIT ❑ BUILDING ING MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING RE PREVENTION SYSTEM
PROJECT
(Provide detailed description of work included on,tfiis vermit onlu)
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
CONTRACTOR
',V
APPLICANT
CONTACT
LENDER
n
NAME PRIMARY PHONE
1—r vtn F-
nr-' or4 hlix/ 1.rncci✓1n4 I ( ) -
COMPANY NAME
h6urn Meckavniao(,L
APPLICANT NAME
Susan Flores
OFFICE PHONE
(253) 838 -9780
MAILING ADDRESS
&A 24-q
CITY, STATE, ZIP
Auburn 1AA 98071
CELL PHONE
(-- -)-- -
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
a() -0 0 - ! 0 a d- 7 -1 -
EXPIRATION DATE
19' /
FAX NUMBER
(2s3)f333 -1384 -
B
L
CONTRACTOR'S REGISTRATION NUMBER (copy of card required with each application)
A Q B U 2 l 8 A
PIRATION DATE
(TI / C)
M S 6 3
( ;)-.-/
COMPANY NAME
Ruburn Mechannicat
APPLICANT NAME
susan F(ores
OFFICE PHONE
(253) 838 -1780
MAILING ADDRESS
V.0. BOX 0-q
CITY, STATE. ZIP
14uburn R R800 1
CELL PHONE
-
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant C3 ^ Agent Other (Describe) �ontracm^
FAX NUMBER
(253) 833 - -! 38¢
NAME cc P
PRIMARY PHONE E
u I
E -MAIL ADDRESS �
urn Me i
�
. .
CB m
71' NAME
UnIver oil geaA,kh Services
MAILING ADDRESS CITY, STATE, ZIP PHONE
P.D. Bo 558 Kin trr r ssia l 0!0 (('Pl0) 7b� -33b0
EXISTING USE 11rq I ( aarel 11__ n.. .. ll PROPOSED USE l �P�Iij Wr
EXISTING ASSESSED /APPRAISED VALUE $ --� �^ Yt C VALUE OF PROPOSED WORK $
SPRI NKLERED BUILDING? W-GS ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES iY1�0�
WATER SERVICE PROVIDER iks L HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 4 AKEHAVEN ❑ HIGHLINE ❑PRIVATE (SEPTIC)
EXISTING USE 11rq I ( aarel 11__ n.. .. ll PROPOSED USE l �P�Iij Wr
EXISTING ASSESSED /APPRAISED VALUE $ --� �^ Yt C VALUE OF PROPOSED WORK $
SPRI NKLERED BUILDING? W-GS ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES iY1�0�
WATER SERVICE PROVIDER iks L HAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 4 AKEHAVEN ❑ HIGHLINE ❑PRIVATE (SEPTIC)
.
AREA DESCRIPTION
EXISTING
3 . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
ld 5t K,2
AIR HANDLING UNITS
EVAPORATIVE COOLERS
FIRST
FANS
BOILERS
FIREPLACE INSERTS
SECOND
FURNACES
DUCTS
_ _ GAS PIPE OUTLETS
THIRD
CHANGE OF USE?
o YES
o NO
FOURTH
UP /SEPA/SU?
❑ YES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED?
DECK(COVERED ?)
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
SalsnpiG
PROPos®
TOTAL
TOTAL R>asTM BF
TOTAL P"PGBFDW
TOTALSF
* *NEW HOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ _
Indicate number of each tyjqe
offixture to be installed or r locate
MECHANICAL
c j
alue Mechanical Work $_
ld 5t K,2
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS
_ _ GAS PIPE OUTLETS
BATHTUBS (orTub/Sbo —r Combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS (Ba(broom Sinks)
VACUUM BREAKERS
Do not include existing
GAS LOGS
HOODS (Commsro al)
RANGES
GAS WATER HEATERS
WATER CLOSETS (rodeo
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
to remain.
REFRIG. SYSTEMS
WOODSTOVES
MISC (Describe)
MISC (Describe)
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 DATE `0-4—
y
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent Contractor ❑ Architect ❑ Other
8`OR OFFM`U8E ONLY
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?
❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin #100 — January 1, 2006 Page 2 of 4 k\Handouts\Permit Application