08-102562' tITYOF RE 9ED - 1 o'�-5-6
ralWa — —
Federal y PERMIT
COMMUNITY DEVELOPMENT SERVICES MAY 22 2008 SF MF CO ME EL PL DE ET
33325 AVENUE • PO BOX 9718 ATI Q N
FEDERAL WAY. , WA WA 9 980639718
253- 835 -2607• FAX 253 -8,M
OF
The following is required inforniErt4dA an incomplete application will not be accepted. Please print legibly (in ink) or h
SUITE /UNIT # !OIUS—tc1 V'
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) 1 AJIILk ' 1 1
(Attach separate r Iagtluy legal descriptiaN
PROJECT • /
TYPE OF PERMIT
LOT SIZE (Sf)
• BUILDING ❑ PLUMBING ❑ MECHANICAL
• DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING tIRE PREVENTION SYSTEM
crrinHnn.,f nvrlc inrL vlPA nn thic nermit nniul �"
PROJECT NAME (Name of Business or Owner Last Name) _( A It 1-<-1 -- j UTA 11- I t V-1111 11X11 l ( I
PEOPLE •' •
PROPERTY
NAME PRIMARY
OWNER H MSS rocKEPa
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
caln
NAME P (,) 1 o Vl "�1 1 1 (v 53) HONE � - � 5 E Ctoc I S S 111 e rCo v `
NAME
Per RCW 19.27.095:
I
PHONE
(020(00) 8a
-
MAILING ADDRESS
PO Box 18301
PHONE
CITY, STATE. ZIP
E 9 19
o r► k1A
E -MAIL ADDRESS
COMPANY NAME_
ISM �;
(� t
APP CANT NAME
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OFFICE PHONE
(QS3)gac0
-(900
LING ADDRESS
I
CITY. STATE, ZIP
°-�G� C mo� t �,c �Fl°lg y 4
CELL PHONE
(
-
C OF FEDERAL WAY BUSINESS LICENSE NUMBER
jLi_ 0 5- 0 -6L,
EXPIRKITON DATE
1 08
FAX NUMBER
(d53)qcjo
-
-a&so
CONTRACTOR'S REGISTRATION NUMBER
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9 PI 1& ON DATE
1 i a T o s
E -MAIL ADDRESS
,
i
COMPANY NAMEry� —� -17- (�
11 S � 1 � tkct
PL CANT NAM
1`I
OFFICE PHONE - ��
(a53) 9 to
1 G ADDRT f�
�
C 5 ATE. ZIP S/ �µ/�� yry �Ur
CELL. PHONE
-
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ther
-
be's (C C
FAX NUMBER
a53
�] %�
"0135 V
caln
NAME P (,) 1 o Vl "�1 1 1 (v 53) HONE � - � 5 E Ctoc I S S 111 e rCo v `
NAME
Per RCW 19.27.095:
Lender Information is required if project value exceeds $5,000
MAILING ADDRESS
CITY. STATE. ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ 1 M. 00
SPRINKLERED BUILDING? LIM ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? AYES ❑ NO
WATER SERVICE PROVIDER HAVEN ❑ HI GHLINE ❑ TACOMA ❑ PRIVATE (WELL) '1 SEWER SERVICE PROVIDER HAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
E7Cl"'MO
PROPOSED
TOTAL
TOTAL EXIST WO SF
TOTAL PROPOSED SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
N FIXTURES
Indicate number of each type offtxture 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
BATHTUBS )orlub /Shower combo)
LAVS )Bathm mSLnks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrwrt)
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
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 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.
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 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. p
SIGNATURE: DATED — O
Property Owner and /or Authorized Agent
FOR bF'FICE USE C�'NLX
a NEW o ADDITION ❑ ALTERATION ❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO BASIC PLAN? o YES ONO
ZONING DESIGNATION CHANGE OF USE? ❑ YES ONO
NEW ADDRESS REQUIRED? ❑ YES ❑ NO UP /SEPA /SU? ❑ YES ❑ NO
PLATTED LOT? ❑ YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin #100 - January 1, 2008 Page 2 of 4 k\,Handouts\Perrnit Application