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08-103032r. + CRY OF D Federal Way RECEIVE® PERMIT SF MF CO ME EL PL DE E COMMUNITY DEVELOPMENT SERVICES iY it 3332 FEDERAL W WAY, WA98063- 971897) 112 3 20AP P LI CATI O N 253835 -2607• FAX 253 - 835 -2609- s_ =,=4 CITY OF FEDERAL WAY The following is required inftTMtion -an incomplete application will not be accepted. Please print legibly (in ink) or type. y /PROPERTY • • SITE ADDRESS (°E J f L W SUITE /UNIT # ASSESSOR'S TAR /PARCEL #� I - % -Z/- & LOT SIZE (sfl LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) CoAa!gs ajesV ('&S -AerX (Attach sepom e for lengthy legal descrwaoN PROJECT INFORMATION TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING DIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Prouide detailed descr' lion of work included on this permit onlu) )O S l I 1 '�" 1 S' S rofe L t + o kmg PROPERTY OWNER CONTRACTOR APPLICANT PROJECT CONTACT LENDER EXISTING USE NAME ('� L I�� fdow )� l -5� 11 tv�NGj�J(yADDRES� S - � CITY, STATE. ZIP � �� E -MAIL ADDRESS COMPANY NA.M'��11 f lnC..h;CANT NAME 1 P)E� ADDRESS uoco 5,AiV) Avg 1 `IELL PHO/NE - . COF FEDERAL WAY LICENSE NUMBER EXPIRATION FAX N BE2 CONTRACTOR'S TRA jNUMBER EXPIRATION D i) 4 5 I�(o O T ! o s E- to_h PANY NAME Oi�l� f 1 1 1 S J `, V1 ��'� N hek r X063) :N4g - a05 L�G� ADDRESS - r � A CITY, com ZIP {rC.�4A 1/11 CELL PHONE RELATIONSHIP TO PROJECT o Architect ❑ Tenant o Agent Xother Ltes% n FAX NUMBER 063)%9(p -0 NAME f # J/ V e /! 1 PRIMARY a n )COLT G� E S I NAME Per RCW 19.27.095: Lender information is required 1 project value exceeds $5,000 MAILING ADDRESS CITY. STATE. ZIP PHONE EXISTING ASSESSED /APPRAISED VALUE $ SPRINKLERED BUILDING? **YES ❑ NO WATER SERVICE PROVIDER AAAKEHAVEN SEWER SERVICE PROVIDER o LAKEHAVEN PROPOSED USE I VALUE OF PROPOSED WORK $ s /D� pp©, 0 FIRE SUPPRESSION SYSTEM PROPOSEP /RrQUIR�D ?��`i� NO ❑ HIGHLINE AI tl PI6AM(A! LL) ❑ HIGHLINE ❑ PRIVATE (SEP i zr As Detailed Subject to -1 !L% . Date 'LoM CoM AREA DESCRIPTION EXISTING S . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT o YES o NO BASIC PLAN? FIRST o NO ZONING DESIGNATION SECOND CHANGE OF USE? o YES o NO THIRD o YES o NO UP /SEPA /SU? ADDITIONAL FLOORS (DESCRIBE) o NO PLATTED LOT? o YES o NO DECK (❑ COVERED OR ❑ UNCOVERED ?) DEMO PERMIT REQUIRED? o YES o NO GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS EXISTING P110— D TOTAL TOTAL M[ MG SF TOTAL P"POSFD SF TOTAL SF * *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $ Indicate number of each type offUture to be installed or relocated as part of this project, Do not include existing fixtures to remain. MECHANICAL Value of Mechanical Work $. AIR HANDLING UNITS BBQS BOILERS COMPRESSORS DUCTS BATHTUBS for Tab /Shower Combol DISHWASHERS DRINKING FOUNTAINS ELECTRIC WATER HEATERS HOSE BIBBS (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION) EVAPORATIVE COOLERS FANS FIREPLACE INSERTS FURNACES GAS LOG SETS LAVS (Bathmom Sinks) RAINWATER SYST SHOWERS SINKS SUMPS GAS PIPE OUTLETS GAS WATER HEATERS HOODS IComme c ap RANGES REFRIG. SYSTEMS URINALS VACUUM BREAKERS WATER CLOSETS rreuea WASHING MACHINES WOODSTOVES MISC (Describe) MISC (Describe) 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 information 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 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 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 a part of this application. SIGNATURE: Owner and /or Authorized o NEW o ADDITION o ALTERATION ❑ 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 W ADDRESS REQUIRED? o YES o NO UP /SEPA /SU? a YES o NO PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO Bulletin #100 - January 1, 2008 Page 2 of 4 klHandouts\Pernut Application