07-105277FaftralWay PERMI"I
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3997IWAM1VUY, A77i•POBOV[971d AppLI CATI 2 ° °7
FEDERAL WAY, WA W -W5971 [ / O
?S9- d95 - ?607• FAX ?59- A95.7609
G{`t y OP FI 0ERAL W ' - X'?, j
The following is required ii{ formation — an incomplete applicati*A�ilA�epted. Please print•legibly (in M4 or type.
SITE ADDRESS ' -•
ASSESSOR'S TAX /PARCEL f _
LEGAL DESCRIPTION (e.g. Acme 1
CONSTRUCTION
ATE ROUTE 9
J$H, WA 98296
G
PROJECT INFORMATION
TYPE OF PERMIT '#-BUILDING O PLUMBING . ❑ MECHANICAL
❑ DEMOLITION 13 ELECTRICAL O ENGINEERING O FIRE PREVENTION SYSTEM
PROJECT. NAME (Name of Business or Owner Last Namel y 11
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
C1-- A'S
NA , •�� \� r
APPLICANT NAME
PRIMARY PHONE
MAILIN ADD 3
llt;-At7��'.Lx�m!5-
-21
C , STATE, ZIP
E-MAIL ADDRESS
PANY NAM
APPLICANT NAME
ICE _PHONE
/ /,{/ //�
MAILING ADDRESS
MAILING ADDRESS
I r J TE, ZIP ` `( �.`
� 1 .
C PHONE
-
FAX NUMBER
OF FEDERAL AY USINESS LICENSE NUMBER .
E 'PIRAI N DATE
FAX NUMBER
CON RACTOR'8 RE018TRATION NUMBER
C/ J
50MATioN DATE
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
( -
NAM4 I PRIMARY PHONE E-MAIL ADDRESS
_ -aQ -
NAME
PerRCW 19.2.7.095: .
Lender information is required {(project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? D YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES O NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
IN PROJECT ••-
AREA DESC N
AREAS
•EXISTING
S . FT.
PROPOSED
$ . FT.
TOTAL
00. FT.
BASEMENT
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
FIRST
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS ireseq
SECOND
SINKS
WASHING MACHINES
HOSE BIBBS
THIRD
NEW ADDRESS REQUIRED?
a YES o NO
ADDITIONAL FLOORS L,DESC , E) „ .,
o YES.
o NO
PLATTED LOT?
DECK (O COVIORM OR D C Ian P)
y0
DEMO PERMIT REQUIRED?
o YES
GARAOE O CARPORT
NUMBER OF FLOORS
zxwnn
raorpss
rorN
ror"ia°srs 0"
ro°'"Lneor°esssr
ron"sr
•'NEW HOMES ONLY".. NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of f cture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ )44 COPY OF BID OR ESTIAM7E MUST BE INCLUDED WITH AppLlCAT1019
AIR HANDLING UNITS EV RATIV Q -OLERS OAS PIPE OUTLETS WOODSTOVES
BBQS FANS GAS WATER HEATERS MISC (Describe)
BOILERS EPLAC SERTS HOODS (c..,I q
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS'
PLUIIWRG '
o ALTERATION.
a REPAIR
BATHTUBS (- T-/she— c—t.4
LAVS (BNhroem shilko
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS ireseq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
NEW ADDRESS REQUIRED?
I certify under penalty of psrJury that I am the property owner or authorized agent of the property owner. I eertV9 that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I e
srt{/j( that I will comply with all applicable
City of Pederal. Way regulations pertaining to the work authorised 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 costs, expenses, and attorneys' fees incurred in the
investigation and dgfense of such efaimh which may be made by any person, including the undersigned, and flied against the city, but only
where such claim aris a reliance of the city, including its officers and employees; upon the accuracy of the information supplied to
the city as a part of is appiieatt
CL , . . .
Owner
o NEW o ADDITION
o ALTERATION.
a REPAIR
o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES, o NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
a YES o NO
UP /SEPA /SU?
o YES.
o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO-
Bulletin # 100 - August 16, 2007 Page 2 of 4 . MandoutAPermit Application