08-1007310
�EUI D � Y -` -0 073(
CITY OF
Federal way PERMIT
COMMUNITYDEVEIAPMENfSERVIJEB 14 2008 SF MF CO ME EL PL DE EN FP
33325 8TM AVENUE
WAY, A 98063 971 9718 p I CATI O N
FEDERAL WAY, WA 980&3 -9718 1� _
253 - 835 -2607• Fj� •C"'
www.cityoffeiltl[I m2C�F FEDCCE
The following is required ration - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY •. •
SITE ADDRESS A c3o'Z si,y :3 3 ZF t� red t? iyl ( (�(JIFi (,l )ASUITE /UNIT #
OIL Of
ASSESSOR'S TAR /PARCEL # 3I _:7_ 3 —2 k `7 - o LA ® LOT SIZE (sfi
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) C-:1 W IA e- C O n Ue 5 fi c>l Y /) n t-
(Attach sepwate page for lengthy legal descr(ptlan)
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit on1u1
A51-aiIAthon DF h5�I �i s l�ai1n►� r -,'rQ. Si112PUS5ior 31AISi-PrV2
PROJECT NAME (Name of Business or Owner Last Na mel El M411 1C LO h
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
NAME
APPLICANT NAME
PRIMARY PHONE
( )
MAILING ADDRESS
CITY, STATE, ZIP
E -MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXP TION DATE
1 °1 - °) v- l 0 s S 1 1- 6 0 -- L
FAX NUMBER
(30Cv)
CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE
1
E -MAIL ADDRESS
COMPANY NAME
cunNu, 0-. ->
APPLICANT NAME
OFFICE PHONE
( ) -
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other
FAX NUMBER
( ) -
NAME
\
PRIMARY PHONE
( ) - pay
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 r�
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 7,000
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
89. FT.
TOTAL
89. FT.
BASEMENT
FANS
GAS WATER HEATERS
MISC (Describe)
FIRST
FIREPLACE INSERTS
HOODS )commercial)
SECOND
FURNACES
RANGES
THIRD
GAS LOG SETS
REFRIG. SYSTEMS
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
LAVS (Bathm,mSink,)
URINALS
MISC (Describe)
GARAGE ❑ CARPORT ❑
RAINWATER SYST
VACUUM BREAKERS
NUMBER OF FLOORS
eweTDro
rnorosm
TOTAL
TOTAL coos MG sr
TOTAL raorossD sr
Tana sr
* *NEW HOMES 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.
MECHANICAL
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 )commercial)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS J— Tub /Sho— ,Comb,)
LAVS (Bathm,mSink,)
URINALS
MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS troneg
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify 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.
Ifurther 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, 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 apart of this application.
SIGNATURE: liti J
o2 DATE l D
Property Owner and /or Authorized Agent
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRE
PLATTED LOT?
❑ ALTERATION
❑ YES ❑ NO
4'. ■ ' 0
❑ YES ❑ NO
❑ REPAIR ❑ TENANT IMPROVEMENT
BASIC PLAN? ❑ YES ❑ NO
CHANGE OF USE?
UP /SEPA /SU?
DEMO PERMIT REQUERED?
• YES ❑ NO
• YES ❑ NO
• YES ❑ NO
Bulletin #100 — August 16, 2007 Page 2 of 4 k\Handouts\Permit Application