08-103051RECEIV
Fed �2 Y -C—) 3 0 5 1
Fedee EMOVE Federal Way
JUN 2 4 2008. F I SF MF CO ME EL PL DE EN P
COMMUNITY I)EVEI,OPMIiN'I' S13HV1 CBS 1-
333258°fHALWIi.WA'1'll•P397 9718 Q DLICATIO '
I %EDF.ItAI. WAY. WA .98003 9718 p^I(nn `a '
2.53.8352007• FAX 253.835.2aErM OF FEDE
www.ci(unl(er /cru(wmr.rom CDc
The following is required ir4formation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
LA Y' P1_�, U
SITE ADDRESS
ASSESSOR'S TAR /PARCEL # _
P L S W ����iWc �y / SUITE /UNIT #
LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acrne Estates, Lot 1) _L'U 11 L4 v (. %-k - /� //�
(Anoah svpr c e rx,yeDin km!;_f ,lr Ic�mr rlesc,Y�mnnI I 7v: 11 PROJECT
• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING A FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on
M
PROJECT NAME (Name qJ*
PROPERTY
OWNER
W
> CONTRACTOR
OW
M_j
W
I-
® AEICANT
2 LL
O
Q
NAME
M 1
'LIP
COMPANY NAMI?
LA
All I
N•' NAME
MAILING ADDRESS .�n
w
OFFICE PI ION
MAILING ADDRESS
CITY. SI'A'113, ZIP
18337
CELL PHONE
c -
(A IY OF FEI)ILRAL WAY 13USINESS LICENSE NUMBER E PIRA11ON
0 0-00-\ 0 g3� -1-� ®� ('�L
DAT1:
�C)O !
FAX NUMBER
(��vs ��bf2
CONTRACTOR'S REGISTRATION NUMBER
XPIRATION DATE
E-MAIL ADDRESS
NF� 9 �Qi6 V, c0
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS .�n
w
Cr1Y, S'1xn ", ZIP I
`ELL PHONE
REI.AHONSHIP TO PRO,IEC'I' �. �,J,�,{�
❑ Architect ❑ Tenant n Agent ,Other CkCAUl A-Wtj
FAX NUMBER
(p.% e6 fg -tom L
PROJECT NAME• cc PRIMAR P11 NE EMAIL ADDRESS
CONTACT J� �, ( S ) 9 - 3
LENDER
Nnrott% Per RCW
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUI D? n YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN n HIGHLINE n TACOMA n PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE (SEPTIC)
19.27.095:
Lender iriformation is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE. ZIP
PHONE..
EXISTING USE PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUI D? n YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN n HIGHLINE n TACOMA n PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN o HIGHLINE ❑ PRIVATE (SEPTIC)
• 0
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
WR'I'ER CWSI I'S rrotl,•p
SINKS
WASI[ING MACHINES
FIRST
BUILDING SHELL ONLY? l i YES n NO
BASIC PLAN?
SECOND
r_I NO
ZONING DESIGNATION
THIRD
CHANGE OF USE?
ij YES
n NO
ADDITIONAL FLOORS (DESCRIBE)
UP /SEPA /SU?
r l YES
DECK (I ] COVERED OR O UNCOVERED ?)
PLATTED LOT? i j YES (i NO
DEMO PERMIT REQUIRED?
GARAGE H CARPORT I I
n NO
NUMBER OF FLOORS
I'
EXISTING
PROPOBEU
TOTAL
TOTAL EXISTING SF
TOTAL PROPOSED 511
TOTAL SF
* *NEW IiOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of future to be installed or relocated as part of this prgject. Do riot Include existing fixtures to remain.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOIIAI,IRS
COMPRESSORS
DUCI'S
PLUMBING
BA'1'II TUBS to na, /siow,•r coinbol
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER I IEA'I'ERS
1JOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORN11VE COOLERS GAS PIPE OUTLbn'S WOODSI'OVES
FANS GAS WR'I'ER HEATERS MISC (Describe)
FIREPLACE INSER'I'S IIOODSiconum•r,kal
FURNACES RANGES
GAS LOG SETS REFIZIG. SYSTEMS
LAVS Wash ), Si„ ks)
URINAI,S MISC (Describe)
RAINWA'I'Elt SYST
VACUUM BREAKERS
SHOWERS
WR'I'ER CWSI I'S rrotl,•p
SINKS
WASI[ING MACHINES
SUMPS
BUILDING SHELL ONLY? l i YES n NO
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 irtformation 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 responsibilityfor compliance with local, state, orfederal 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 rglEance of the city, including its officers and employees, upon the accuracy of the information supplied to
the city as a part of this application
SIGNATURE:
er and /or
FOR OFFICE USE ONLY
Lj NEW t i ADDITION
ALTERATION
n REPAIR TENANT IMPROVEMENT
BUILDING SHELL ONLY? l i YES n NO
BASIC PLAN?
ij YES
r_I NO
ZONING DESIGNATION
CHANGE OF USE?
ij YES
n NO
NEW ADDRESS REQUIRED? t i YES cJ NO
UP /SEPA /SU?
r l YES
t_I NO
PLATTED LOT? i j YES (i NO
DEMO PERMIT REQUIRED?
tl YES
n NO
Bulletin #100—January I, 2008 Page 2 ol•4 k \Handouts\Permit Application