07-100607ciry OF
Federal Wa
PERMIT:
COMMUNITY DE VELOPMENT SERVICES F MF CO ME EL PL DE E FP
33325 8WAI;ENUE SOUTH - PO BOX 9718
FEDERAL WAY, WA 98063-998 0 2 20o? APPLICATION D
.253-835-2607- FAX 253 8,5
ym1w CifyoredeqRwyll.com
Thefollowin -AP*kA?X49!y— an inco . mplete application will not he accepted. Please print legibly'.(in inP4 or type.
SITE ADDRESS
SUITE/UNIT#
ASSESSOR'S TAX/PARCEL # LOT: SIZE
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Affach sep�fap-gf-l-wthy 1"I dm�ipfi6n)
PROJECT INFORMATION
TYPE OF PERMIT
0 BUILDING .0 PLUMBING 0 MECHANICAL
0 DEMOLITION 0 ELECTRICAL *0 ENGINEERING RE, PRLVMTION SYSTEM
f work ikicluded on this Perm
PROJECT DESCRIPTION (Provide detailed descr�otion o it onjW XF,
PROJECT NAME (Name of Busines or Owner Last Nam
PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
COPY f �"4 "quind
.1th ".3% ppH"U..
APPLICANT
PROJECT
CONTACT
LENDER
N
PRIMARY PHONE
MAILINGYrDURESS
CITY, STATE,
E-MAIL ADDRESS
OMPANY NAME
APF1LI%NT NAME
APjICW4NT NAM
t
OF E
0
'MAILING
ADDRESS
KSLATIONSHIP TO PROJECT
CrIx STATE, ZIP
C ELL PHONE
-61 )! �-
WSINESS I
FAX NUMBER
a
r2i
)q�c�
QRS REGISTRATION
NUMBER
EXPIRAT
E-MAILADDRESS
ANY NAME .1
APF1LI%NT NAME
OFFICE I PHONE
MAIL 0
11 A RESS C��
gMIJTATE, ZIP
'ONE
KSLATIONSHIP TO PROJECT
FAX NUMBER
o Architect o Tenant 0 Agent 1i Other
NAME PRIMARY PHONE E-MAIL ADDRESS
I.- n �� (,Cq i ;W, -[7) 1
-WA—ME
P&RCW19,27.095:
Lender information is required Jfproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHORE
FMSTINGUSE PROPOSED USE
EXISTING ASSESSED/APPRAISED VALUE VALUE OF PROPOSED WORK
PPRINKLERED BUILDING? '' 6--Iff,�S 13 NO FIRE SUPPRESSION SYSTEM PkOPOSED/REQU=D? YES 0 NO
X,
WATER SERVICE PROVIDER 0 LAKEHAVEN 0 HIGHLINE 0 TACOMA 0 PRrVATE (WELL)
SEWER SERVICE PROVIDER 13 LAMIAVEN uHIGHLINE 0 PRIVATE (SEPTIC)
AREA DESCRIPON EXISTIN
SQo FT'
PROPOSED TOTAL
SQ. FT. SQ.: FT.
]�ASEME`NT
FANS
BOILERS
FIREPLACE INSERTS
IRST
3,15�\oo koum-
D
GAS LOG SETS
ECOND
BAT14TUBS f- T.�Ah C..W)
LAVS (13aid— Sink4
T14IRD
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ADDITIONAL FLOORS (DESCRIBE)
SINKS
HOSE BIBBS
SUMPS
DECK (0 COVERED OR 0. UNCOVERED?)
D YES a NO
DEMO PERMIT REQUIRED?
GARAGE 0 CARPORT 13
a NO
NUMBER OF FLOORS____F
P1101081E D
I TOTAL
TOTAL F_=71NO SF
TOTAL PROPOSSD Sr
TOTAL a),
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
or relocated as part of this project. Do, not include existingfixtures to remain.
Indicate number of each type offixture to be installed
Value of Mechanical Work
(ACOP OF BID -OR ESTIMATE MUST BE INCLUDED MTH APPLJCATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBQS
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
D
GAS LOG SETS
PLETMING
BAT14TUBS f- T.�Ah C..W)
LAVS (13aid— Sink4
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
ELECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (c�ercia4
RANGES '
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (T.ikl)
WASHING MACHINES
WOODSTOVES.
MISC (Describe)
MISC (Describe)
I certVy underpenalty ofporjury !hat the information furnished by me is true and correct to thebest of. my knowledge, andfurthqr, tftat I
am authorized by the owner of -the above promises to perform the work for which the permit application is made. I further agree to hoU
h armless 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 undersignect andflied,against the City ofFederal 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 _'
RELATIONSHIPTO PROa& 0 Owner 0 Agent ntractor o Architect 11 Other
NEW a ADDITION
o ALTERATION
o REPAIR TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
DYES ONO
BASIC PLAN?
D YES
0 NO
ZONING DESIGNATION
CHANGE OF USE?
D YES
13 NO
NEW ADDRESS REQUIRED?
a YES 0 NO
UP/SEPA/SU?
a YES
ONO
PLATTED LOT?
D YES a NO
DEMO PERMIT REQUIRED?
13 YES
a NO
E
Bulletin # 1.00 —January 1, 2007 Page 2 of 4 k4landoutsTermit Appfication