08-104057N. 1% RECEJ'ED 0
My of 'A AUG 2 8 2008 d S
Federal wQTcX OF FEDERAL' "MIT
COMMUNPIYDEVEIAmP c SF MF CO ME EL PL DE EN
33325 RAWDAEY, W 96908
FEDERAL 9718
cDAPPLICATION
253.835 -2607• FAX 253- 835 -2609 -'/
www.cittloffederahvau.com 1
The following is required igformation - an incomplete application will not be ted. Please print legibly (in inlo or type.
W PROPERTY INFORMATION
SITE ADDRESS 2>5'4'
> 2 '7'4 15pf PL- .L� SUITE /UNIT #
ASSESSOR'S TAX/PARCEL # -22- D Z Q -4 - g I LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach -paw pagefor btW ft te,9W deb 1ptbN
E PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
I N AN"M 1--L- -" 00 OP +=r->C1
PROPERTY
NAME
PRIMARY PHONE
OWNER
JA- j1*
(aXD) - (OZJ4
(?wo ) BZy'
MAILING ADDRESS
CITY, STATE. ZIP
E- MAILADDRESS
CELL PHONE
(zo&) #23 - z2S>,
t:in h.
M iii
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
zofj 12-s. INC
POI .A-- -L w i 1..0eR -S
(7X& ) 8X44 -8001
(?wo ) BZy'
-9®o
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
(zo&) #23 - z2S>,
S o
M iii
(wb) Z
-2Z5&
CITY OF FEDE WAY BUSINESS LICENSE NUMBER
IRATION DATE
FAX NUMBER
0�?1? -C >
(2 3 l o�
( ) s f
-9030
CONTRACTOR'$ REGISTRATION NUMBER
TION ATE
E MAIL ADDRESS
-D
�6 0� ZD,o
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
zofj 12-s. INC
o r-) w�F U,.-
(7X& ) 8X44 -8001
MAILING ADDRESS
CITY, STATE. ZIP
CELL PHONE
8rnc tb 9
OCS Iff/ 9B
(zo&) #23 - z2S>,
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent )< Other I wJ TAA, CL 100 -
( ZO-- ) ta,;?A4 - g 60 1
NAME PRIMARY PHONE E -MAIL ADDRESS
L- 1"&) 25 - 5� :1
NAME
Per RCW 19.27.095:
Lender information is required (f prgject value exceeds $5,000
MAILING ADDRESS
CITY. STATE. ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? AYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? )(YES ❑ NO
WATER SERVICE PROVIDER KLAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER V LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
$ - 0 •
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
89. FT.
TOTAL
SQ. FT.
BASEMENT
WOODSTOVES
BBQS
FANS
FIRST
MISC (Describe)
BOILERS
FIREPLACE INSERTS
SECOND
a NO
COMPRESSORS
FURNACES
THIRD
UP /SEPA /SU?
DUCTS
GAS LOG SETS
ADDITIONAL FLOORS (DESCRIBE)
a YES a NO
PLUMBING
DEMO PERMIT REQUIRED?
DECK (❑ COVERED OR ❑ UNCOVERED ?)
a NO
BATHTUBS (or Tub /shower Combo)
LAVS IBan000msmks)
GARAGE ❑ CARPORT ❑
MISC (Describe)
DISHWASHERS
RAINWATER SYST
NUMBER OF FLOORS
ZMTM
,Roma®
TOTAL
TOM MUST910 51
TOTAL morom AW
Tarv.sr
"NEW HOMES ONLY"* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type offixture to be installed or relocated as part of this project. Do not include existing factures 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 )CommerciQ
a NO
COMPRESSORS
FURNACES
RANGES
UP /SEPA /SU?
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
a YES a NO
PLUMBING
DEMO PERMIT REQUIRED?
o YES
a NO
BATHTUBS (or Tub /shower Combo)
LAVS IBan000msmks)
URINALS
MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrowt)
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I certVy under penalty qr perjury that I am the property owner or authorised agent qr the property owner. I certify that to the best qr my
knowledge, the information submitted in support of this permit application is true and correct. I cert fry that I will comply with all applicable
City qr Federal Way regulations pertaining to the work authorised by the issuance qr a permit. I understand that the issuance qr 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 qr Federal Way as to any claim (including casts, expenses, and attorneys' fees incurred in the
investigation and dgfwwe qr such claim), which may be made by any person, including the undersigned, and filed against the city, but only
where such claim arises out qr the reliance qr the city, including its officers and employees, upon the accuracy qr the inrormation supplied to
the city as apart grthis opplic�g,
Y �
Owner and /or
u NEW u ADDITION
a ALTERATION
a REPAIR a TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES a NO
BASIC PLAN?
❑ YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
a YES a NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT?
a YES a NO
DEMO PERMIT REQUIRED?
o YES
a NO
Bulletin #100 - January 1, 2008 Page 2 of 4 • klHandouts\Permit Application