08-102557Fe WCEIVEr
PERMIT
aoliA M, DELBLOPABMI'sERFrces
333958" RU WA 50ULH • PaaoX 'MAY " "Ik P P LI CAT I O N
PEDBRAL WAY, WA 98063.9718
20-M.5-207- 07• PAX 25343S•9609
N7F1F.nf TY C. FEDERAL WAY
The folio s requtrsd MfetiMation -an incomplete application will not be accepted. Please print legibly (in inP4 or type.
f -�- 1_,55-7
SF MF CO ME EL PL DE EN PP
SITE ADDRESS 2 7g 230 'r'aLc- I S'i C Hwy. S - Te ,f E le l win 4 SvITEIumT •
ASSESSOR'S TAX /PARCEL # _ _ _ _ _ _ _ _ LOT SIZE (sn
LEGAL DESCRIPTION (e.g. Aome Estates, Lot 1)
■ PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING)(FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlvl
trl� i r'2 O�nr i n. i ('orrll�le t? �''' t�lcit^m Spica -k)
on QkAle,A Ridc4r' Ci r7-1.
PROJECT NAME (Name of Business or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
■ PEOPLE INFORMATION
nP,
COMPANY NAME
CANT E _
CANT NAME
OFFICE PHONE
, STATE, 71P -
CELL PHONE
....
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oil 0011
. ��i ,� =�LwIYiQ/l%I��7f/1O17IfR - %iY• a L'IIII�I���7/ta[�ltiLfr
COMPANY NAME
CANT E _
CANT NAME
OFFICE PHONE
, STATE, 71P -
CELL PHONE
oxAr) s evj
FAX NUMBER
MAILING ADDRESS
�(aav rah
CITY, STATE, ZIP
zai
CELL PHONE
bob -�f�7z
CLTY OF FEDERAL WAY BUSINESS LICENSE NUMBER RATION DATE
FAX NUMBER
Z1966
3
NAME
CONTxACTOx'B
ER EEPUtATION DATE
(�
E-MAIL ADDRESS
D €tom tric6
PHONE
MPANY NAME
M
CANT E _
OFFICE PHONE
M " ADD7
/b
, STATE, 71P -
CELL PHONE
RELATIONSHIP TO PROJECT
o Architect ❑ Tenant a Agent ❑ Other
FAX NUMBER
NAME
PRIMARY PHONE
&MAIL ADDRESS
NAME
pe .5095:
nder ir{(orsuldon is required {/project oniue exceeds 05,000
MAIL NO ADDRESS
CITY, SPATE, ZIP
PHONE
EXISTING USE PROPOSED USE f ? 6 rj00 - d O
EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK $
SPRiNKLERED BUILDING? 17 YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES 0 NO
WATER SERVICZ PROVIDER o LAKEHAVEN o IIIGHLINE ❑ TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE iSEPTICI
av/
=cam+ -1
AREA DESCRIPTION
ERISTING
PROPOSED
TOTAL
BASEMENT
a YES a NO
. FT.
8 . FT.
FIRST
o NO
=r
SECOND
CHANGE OF USE?
-
a NO
THIRD
o YES a NO
UP /SEPA /SU?
ADDITIONAL FLOORS (D CRIBS)
a NO
PLATTED LOT?
o YES o NO
DECK (❑ COVERED OR ❑ COVERED ?)
DEMO PERMIT REQUIRED?
a YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
°
rwrosm
O
far" i
rormof
"NEW HOMES ONLY" NUMBER OF ROOMS ESTI TED SELLING PRICE $
Indicate number of each type of fixture to be
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS.
PLUbIBING
BATHTUBS Iwrub /shw
DISHWASHERS
DRINKING FOU N9
(A
FIREPLACE INSERTS
FURNACES
GAS LAG SETS
LAVS Is dm akd*
RAINWATER SYST
SHOWERS
ELECTRIC WA HEATERS SINKS
HOSE BIBBS SUMPS
as part of this project. Do not include existing fwtures to remain.
ESTIMATE MUST BE INCLUDED WITHAPPLICATION)
GAS PIPE OUTLETS
GAS WATER HEATERS
HOODS Icommwdo
RANGES '
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS era"
WASHING MACHINES
WOODSTOVES
M1SC (Describe)
MISC (Deacribel
I cw1W under penalty q/P*durg that I am the property owner or authorised agent of the properly owner. ! cwtW that to the best of my
knowledge, the b{formation submittM in support of this permit application is true and correct. I certi/g that I win comply with an appitcabte
City of Federal Way regulations pertaining to the work authorised by the isncance of a permit. I understand that the issuance of this permit
doss not remove the owner's responsibility for compliance with toeat, state, or federal laws regulating construction or environmental laws.
I further agree to hold harmless the City of Federal Wag as to any claim (Including coste, expenses, and attorneys' fees incurred in the
investigation and defense of such eta". which may be made by any person, including the undersigned, and filed against the city, but only
when such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the- hjbrmadon supplied to
the Mty as a part this application
SIGNATURE:
o NEW o ADDITION
a ALTERATION
o REPAIR a TENANT IMPROVEMENT
BUILDING SI ELL ONLY?
a YES a NO
BASIC PLAN?
a. YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
o YES a NO
UP /SEPA /SU?
o YES
a NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 — January 1, 2008 Page 2 of 4 MandoutslPennit Application