08-103031CITY OF 0 5 0
RECEIVED
Federal Way PERMIT — —
COMMUNITY DEVELOPMENT SERVICES
SF MF CO ME EL PL DE EN
33325 8- AVENUE SOUTH • PO 8OX 9718 UN 2 3, P LI CATI O N
FEDERAL WAY. WA 980639
253- 835 -2607• FAX 253 835 -2609 718
-
CITY OF FEDERAL WAY
The following is required inforMgon - an incomplete application will not be accepted. Please print legibly (in ink) or type.
9 (� PROPERTY O.
SITE ADDRESS �7 r °_� r%L SUITE /UNIT #
ASSESSOR'S TAX /PARCEL #� I - 6(— LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) Co, *f ' Lf/ eV NaShr Z
(Attach separa a for lengthy legal descHptloN
PROJECT • '
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )OIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this per nit onlu)
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY
OWNER
.,(n K iers
NAME
PL TNAME�� `
PRIMARY PHONE *79y
ooto )SA -5 I -1`7
rOI., S
C[TY, ST �I Z o�� g
E-MAIL ADDRESS
CONTRACTOR +O MPf
APPLICANT
PROJECT
CONTACT
LENDER
�5mi
m Inc.
PL TNAME�� `
OFFICE
�� )" 1 �O ✓�
CITY S�T/� n/ZI�P%, � � , r �, r
!ELL PHONE
SINESS ��� LICENSE ER p EXPIRATION 2 t O�
L G
/FAX N� BE�2 ��-
(95 ) /N�j }, oTffi 0.
` Is '�to Q • EICP11 Ti�A09
�
E-MAIL f�Crf IS 11
PLIC E
Vhk' ki NAM toeh r
OFFICE PH NE
ca53) 4£� - has
CITY, STATE, ZIP
a- colna, j0A 78 ,V21
CELL PHONE
RELATIONSHIP TO PROJECT��
❑ Architect ❑ Tenant ❑ Agent XOther +
NAME ' I r, PRIMARY PHONE E-MAIL ADDRESS S
h / aIM) VL-h /4 V 7o v[
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS CITY. STATE. ZIP PHONE
EXISTING USE __ PROPOSED USE LL/,
EXISTING ASSESSED /APPRAISED VALUE $ _ _ VALUE OF PRiiO��P��O��SjjED WORK $ earr _'18 30 00�a
SPRINKLERED BUILDING? ❑ NO FIRE SUPPRESSION SYST gIZOPO A, D9rDa. TES f t rlft� u ei
WATER SERVICE PROVIDER HAVEN ❑ HIGHLINE ❑ TAC n�❑Pu�Rt(IVATE L) ��3`'d
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ Pi5EP[n7S�
By
Date
-COM
COM
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
WATER CLOSETS (roue)
SINKS
WASHING MACHINES
FIRST
ZONING DESIGNATION
SECOND
o NO
NEW ADDRESS REQUIRED?
o YES o NO
THIRD
UP /SEPA /SU? o YES
o NO
PLATTED LOT?
ADDITIONAL FLOORS (DESCRIBE)
DEMO PERMIT REQUIRED? o YES
o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTING
PROPOSED
TOTAL
TOrAL EX79TINO SF
TOTAL PROPOSED sr
TOTAL SF
* *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
MECHANICAL
Value of Mechanical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES
BB9S FANS GAS WATER HEATERS MISC (Describe)
BOILERS FIREPLACE INSERTS HOODS (co —,-all
COMPRESSORS FURNACES RANGES
DUCTS GAS LAG SETS REFRIG. SYSTEMS
BATHTUBS (or Tub /sho—rCombo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom SInksl
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (roue)
SINKS
WASHING MACHINES
SUMPS
ZONING DESIGNATION
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 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 apart of this application.
SIGNATURE:
Owner and /or Authorized
o NEW o ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
„
„BASIC PLAN? o YES
o NO
ZONING DESIGNATION
CHANGE OF USE? o YES
o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU? o 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 MflandoutsTermit Application