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08-1027210 2 CtroF CEIVEt Federal AT- PERMIT COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE EN FP 3332111- AVENUE SOUTN•PO BOX 9�(8)N o 3 XPPLICATION FEDERAL WAY, WA 98063 -9718 v 253 835 2607 FAX 253-835-2609 OF FEDERAL WAY The follo. q rY equired yrfaCLwation - an incomplete application will not be accepted. Please print legibly (in ink) or type. SITE ADDRESS 5 (r '� 9 n d V (� /,. SUITE /UNIT # lus�e Y ( I ASSESSOR'S TAX /PARCEL # � -a -Q �n Aa H - ���� (_�1 -1l LOT SIZE (sf% LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Attach separa page far lengthy legal descriptloN TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING YFIRE PREVENTION SYSTEM PRn.iFCT nR..Qr:RTPTTnN for- sirlp rlotnilprl rlacrrintinn of mnrlr inclurlerl nn this nermit onlui PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER CONTRACTOR APPLICANT PROJECT CONTACT LENDER NAME Tloca Romts n r PRIMARY PH (qtu u 091 GAD � S ^ CITY, STATE. ZIP �� ^� � E -MAIL ADDRESS COMPANY NAM F,�- InC ( thl APPLICANT NAME j y, r OFFICE t 8L�) ( � tL[NG ADD CITY. STA .ZIP f ELL PHONE - CZY OF FEDERAL WAY BUSINESS LICENSE NUMBER IRATION ATE -© -oQ- L i �{ og FAX NUMBER - a a3so CONTRACTOR-�n-'S I RATION NUMBER EXPIRATION DATE i� E -MAIL ADDRESS COMPANY NAME-h 'S�e ryAs I1 lc` 1,L'I`INN,G APP�I � NAME �� T 1 r OFFICE (o ADDRESS t STATE, VIP CELL PHONE RELATIONSHIP TO PROJECT Agent •, , r ❑Architect ❑Tenant ❑ t ther LL / r� )�� a� l NAME Ql.� J� ` PRIMARY PH - / affl��f NAME PerRCW 19.27.095: Lender information is required if project value exceeds $5,000 MAILING ADDRESS CITY. STATE, ZIP /PHONE l ) - EXISTING USE PROPOSED USE V2t.. EXISTING ASSESSED /APPRAISED VALUE $_ VALUE OF PROPOSED WORK $ J 0 SPRINKLERED BUILDING? JIQJYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ( v R&S ❑ NO WATER SERVICE PROVIDER ><LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) WE. co M1 0 r era&l AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT BBQS FANS GAS WATER HEATERS MISC (Describe) FIRST FIREPLACE INSERTS HOODS (Commercial) COMPRESSORS SECOND RANGES DUCTS GAS LOG SETS THIRD PLUM JWG o YES ❑ NO ADDITIONAL FLOORS (DESCRIBE) LAVS (Bathroom Sinks) URINALS MISC (Describe) DISHWASHERS DECK (❑ COVERED OR ❑ UNCOVERED ?) VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS GARAGE ❑ CARPORT ❑ ELECTRIC WATER HEATERS SINKS WASHING MACHINES NUMBER OF FLOORS ExmS m- PROPOSED TOTAL TOTAL FMSrnVO 51' 7MAL PROPOSM SF rarAL SF * *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ FIXTURES Indicate number of each type offixture 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 (Commercial) COMPRESSORS FURNACES RANGES DUCTS GAS LOG SETS REFRIG. SYSTEMS PLUM JWG o YES ❑ NO BATHTUBS (or Tub /shower combo( LAVS (Bathroom Sinks) URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS nbiiet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS certt 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 irformation submitted in support of this permit application is true and correct. I certify that 1 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 responsibilityfor compliance with local, state, orfederal laws regulating construction or environmental laws. I further agree tQ 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: Owner and /or Authorized o NEW o ADDITION o ALTERATION o REPAIR o TENANT IMPROVEMENT BUILDING SHELL ONLY? t7 YES o NO 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? o YES ❑ NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin #100 -January 1, 2008 Page 2 of 4 k\Handouts\Permit Application