08-104058RECEIVED
AUG 02008
Federal WaICITy OF FEDERVLL*VIT
COMMUMIY DEVELOPMENT SERVICES
33325 Sn+AVENUE SOUTH • Po BOX 9736
2FEDERAL 607E X"253- 3592 PLI CATI O N
www. cituoffederalwau.com
SFMFCOMEELPLDEENFP
The following is required it }formation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY INIORINVITION
SITE ADDRESS �S2 3P4 �-- J SUITE /Umm •
ASSESSOR'S TAX /PARCEL M 32;1- Q 2 1 Q —4 - Or -L IP LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates. Lot 1)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING )(F= PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul
I N �'Ti'+ (— (. —h'Tt 00 &- -FC> C-,
PROJECT NAME (Name of Business or Owner Last Namel
PROPERTY
OWNER
IsPgaa- :T,TAi *YA
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
PRIMARY PHONE
OFFICE PHONE
MAILING ADDRESS
MAILING ADDRESS
CITY, STATE. ZIP
E- MAILADDRESS
- co t
h.
ft 50X g
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS
CITY, STATE. ZIP
CITY, STATE, ZIP
(7wo
CELL PHONE
- co t
MAILING ADDRESS
ft 50X g
M e5
(20b) 2
-=5fo
CITY OF F Er WAY BUSINESS N E BER
0`;
EXPIRATION DATE
2 31 o 2�
FAX NUMBER
(SO& ) Sul
- 9030
R'11 RRGIWMI70N MUIMER
9XPM%ATION TE
E- MAILADDRESS
05 /0q /Zo1 o
COMPANY NAME
pb"I —� l t, t�e,Z /N
APPLICANT NAME
L3 w� li.
OFFICE PHONE
(� )67-4 -goo (
MAILING ADDRESS
CITY, STATE. ZIP
CELL PHONE
30 %
lx5 Moi �( aL� l 98
( &) #23 - z2SG
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent )(Other faAa A!L 1
( Z4z ) O.W - got I
NAME PRIMARY PHONE E -MAIL ADDRESS
L- (u&) tf z3 - 5(V
NAME
per RCW 19.27.095:
Lender information is required (f prgjeet value a eeeds $5.000
MAILING ADDRESS
CITY. STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? AYES ❑ NO
WATER SERVICE PROVIDER YQLAKSHAVEN
SEWER SERVICE PROVIDER U LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $ c-0
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? )(YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGEMME ❑ PRIVATE (SEPTIC)
'A 7r 1 0
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
89. FT.
TOTAL
89. FT.
BASEMENT
U ALTERATION
U REPAIR ❑ TENANT IMPAOVEI[ENT
FIRST
BASIC PLAN? a YES
a NO
SECOND
CHANGE OF USE? U YES
THIRD
NEW ADDRESS REQUIRED? U YES U NO
UP /SEPA/SU? ❑ YES
ADDITIONAL FLOORS (DESCRIBE)
PLATTED LOT? U YES ONO
DEMO PERMIT RRQUBM? U YES
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
=MTM
moroeeo
rozec
rorer, ZZWNo sr
rorw rsorneso W
roar, er
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of future to be installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechaticai Work $.
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (o T b /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ES7 MATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
LAVS (B"thmom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
GAS PIPE OUTLETS
GAB WATER HEATERS
HOODS (cm—cia
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS rr ikq
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I ow t(fy undo penalty of perjury that I am the property owner or authorised agent qr the property owner. I certt that to the beet of my
knowledge. the information submitted in support of this permit application is true and correct. I cotVy that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised 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 taws regulating construction or environmantal laws.
I further agrav to hold harmless the City of Federal Way as to any claim (tncluding costs expenses, and attorneys' fas incurred in the
investigation and dgfense of such claim), which may be made by any person, including the undersigned, and flat against the city, but only
where such claim arises out qr the reliance qr the city, including its officers and employees, upon the accuracy of the btAwmation supplied to
the city as a part grthis appliegUmg,._
II •
Bulletin #100 -January 1, 2008 Page 2 of 4 Mandouts\Permit Application
L NEW U ADDITION
U ALTERATION
U REPAIR ❑ TENANT IMPAOVEI[ENT
BUILDING SHZLi. ONLY? U YES U NO
BASIC PLAN? a YES
a NO
ZONING DESIGNATION
CHANGE OF USE? U YES
U NO
NEW ADDRESS REQUIRED? U YES U NO
UP /SEPA/SU? ❑ YES
U NO
PLATTED LOT? U YES ONO
DEMO PERMIT RRQUBM? U YES
U NO
Bulletin #100 -January 1, 2008 Page 2 of 4 Mandouts\Permit Application