09-100090RECEIV FOD
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COM,WUMTr DEV=PMArYT SERVICES
JAN 0 8 2009 PER MIT SF MF CO ME EL P DE EN FP
33325 81w AVBNUS SOUTH • Po BOX 9718 �'r�,a�I CATI O N
ASDSRAL WAY,
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The following is fared W D s
raga informailort –an incomplete application wZZI not be accepted. Please print legibly (ire ink) or tiJpe•
SITE ADDRESS _
SUITE /UNIT #
ASSESSOR'S TAX /PARCEL # — — — — — �j— LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
PROJECT •- •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
A DEMOLITION ❑ ELECTRICAL ❑ ENG=z==G ❑ FIRE PREVENTION sraT$M
DESCRIPTION (Provideetaile d descnp ' of work ' on this permit onlvl
PROJECT NAME (Name ofBu
Smess or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
® PEOPLE INFORMATION
N
_-- /
PRIMARY PHONE
MAILING ADDRESS n,
STATE, ZIP
E-MAIL ADD
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
CITY OF FE A BUSINESS LICENSE NUMBER EXPIRATION DATE
FAX NUMBER
CONTRACTOWS REGISTRATION NUIOZR 8XPIRATION DATE
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect Tenant ❑ Agent ❑ Other
C1(1wx1_)
E PRIMARY PHONE I E-MAIL ADDRESS
/ mil/ 7v—,,—,7 — ll v 'wc
NAME
Per RCW 19.37.095:
Lender information is required if project value avoeeds $4000
MAILING ADD
CITY, STATE, ZIP
PHONE
EXISTING USE /%� , - - - - - - - - - - - - - - r
PROPOSED USE �J
EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK $
SPRMELERED BUILDING? ❑ YES 4 NO FIRE SUPPRESSION SYSTEM PROPOSED /RBQMRED? ❑ YES NO
WATER SERVICE PROVIDER ❑ LAKEHAV N ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER 13 LAREHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
•
It
AREA DESCRIPTION
E8I3TING
3 . FT.
PROPOSED
SO. FT.
TOTAL
SQ. FT.
BASEMENT
FIREPLACE INSERTS
COMPRESSORS
FURNACES
FIRST
GAS LOG SETS
G
SECOND
LP►VS tswWo SWq
DISHWASHERS
RAINWATER SYST
THIRD
SHOWERS
&LECTRIC WATER HEATERS
SINKS
ADDITIONAL FLOORS (DESCRIBE)
SUMPS
PLATTED LOT?
a YES a NO
DECK (0 COVERED OR 0 UNCOVERED ?)
DEMO PERMIT REQUIRED?
a YES
a NO
GARAGE 0 CARPORT
NUMBER OF FLOORS
°O
TMAL
70n'aAIMIU1Oar
Tares sarostasr
Torecsr
"NEW HOMES ONLY*" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each iJpe offixture, to be installed or relocated as part o. f this project. Do not include existing fixtures to main.
Value of Medianical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
BBW
FANS
BOILERS
FIREPLACE INSERTS
COMPRESSORS
FURNACES
DUCTS 2/Cxb*
GAS LOG SETS
G
BATHTUBS t :Tnxb/
LP►VS tswWo SWq
DISHWASHERS
RAINWATER SYST
DRINKING FOUNTAINS
SHOWERS
&LECTRIC WATER HEATERS
SINKS
HOSE BIBBS
SUMPS
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (comaq
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS (ruaq
WASHING MACHINES
WOODSTOVES
MISC (Deacnle)
MISC (Describe)
1 ca to y under penaltq of perjurq that 1 am the p vVerV owner or audwrissd agent of the popwV wMer. t caY�jfy that Lo the best of rr+y
kreomted9% the irq&rmmtion submitted in support of this permit application is true and correct 1 cetW that 1 will aompig with aU appamble
City of Fedend Wag mJulattons pertaining to the work authorised bg the issuance of a permit 1 understand that the issuance of ddspermit
does not remove the owner's responsibility for eompUance with locay state, or f-hwW lams regulating construction or snWronmental taws.
1 further agree to hold harmless the City of Federal Wag as to any claim (inetu V-g vests, wq nses, and attorneys' fees incurred in the
irevestigattoa and detenst Of such claim), which mug be made bg any Per M irechcding the undersigned, and ft led against the ctIM but only
where such claim wi4s out of the reliance of the city, inabndin ere and employees, upon the accuraag of the btrormation supplied to
the city as a part of application
SIGNi(TURE: DATE
a NEW a ADDITION
a ALTERATION
a REPAIR a TENANT IDRPROVEMENT
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN?
a YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
o NO
NEW ADDRESS REQUIRED?
a TES o NO
UP /SEPA /SU?
a YES
a NO
PLATTED LOT?
a YES a NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 — January 1, 2009 Page 2 of 4 k\Handouts\Permit Application