08-100382r Fed sy RECEIVEL -
COMNUAMDEVELOPNENTSERVM.88 PERMIT SF MF CO ME EL PL DE E F
39929 AVENUE SOUTH 9 6397197tdAN 2 5 ZO PPLICATION pd.Please -
259.895.2607• FAX 253-8.75.260 /
tom-di uorrcsdaak um CrTY OF FEDERAL WAY :::
The following is required t7 rDmation - an incomplete application will not be accep print leg ftty
PROPERTY INFORLIATION
)�/
SITE ADDRESS `i �%/1 /' ' {t /' I�
ASSESSOR'S TAX /PARCEL 6 d %� - Q �f /?
LOT SIZE (s�
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 2)
l^e� -q..4wwA *kMft k9dd..aaes0 - --
OMER-
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUMDING ❑ PLUMBING ❑ MECHANICAL
0 DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING NeF RE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this Permit only)
F
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4i, JrP- Pfo4eL'�'9w VI_ -'�� -1 �jJ H'1 %1>'"� Ai A i, i
PROJECT NAME (Name of Business or Owner Last Namel
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
In
•
COMPANY NAME APPLICANT NAME
!7 � i OFFICE PHONE
F
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CITY OF FEDERAL WAY BUST ESS LICENSE NUMBER EXPIRATION DATE FAX NUMBER
00 'B RY,ODTTRATION NUMBER. B,RP T10N DATE L•MAIL ADDRESS
COMPANY NAME I
APPLICANT NAME
OFFICE PHONE
MAiLINO ADD
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect t7 Tenant ❑ Agent ❑ Other
L ) _
...+m "Di��i�i n - J'��Vl� ✓��� I �ii � �v�G]7 - 3y I j E-MAIL ADDRESS
NAME Per RCW 19.27.095:
Lender Wormation is required if project vatue r &&ds !s_ono
E STING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? 13 YES 17 NO
WATER SERVICE PROVIDER o LAKEHAVEN
SEWER SERVICE PROVMER O LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $- )_ 00 0
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? M-t= O NO
• HIGHLINE ❑ TACOMA O PRIVATE (WELL)
• HIGHLINE ❑ PRIVATE ISEPTICI
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
8 . FT.
BASEMENT
o YES ONO
BASIC PLAN?
FIRST
o NO
ZONING DESIGNATION
SECOND
CHANGE OF USE?
a YES
a NO
THIRD
G YES o NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT?
a YES o NO
DECK (O COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
a YES
o NO
GARAGE O CARPORT O
NUMBER OF FLOORS
ffieT°e
rsoTwse
Toro,
roracsmnxoer
Torursarouosr
rorasr
"NEW HOAW ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate. number of each type of fixture to he installed or relocated as part of this project. Do not include existing fixtures to remain.
Value of Mechanical Work $ fA COPY OF BID OR ESTIMATE MUST BE INCLUDED RMAPPLICATIONJ
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS.
BATHTUBS WT%b /shm cm"
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS LOO SETS
LAVS (840 m sh"
RAINWATER SYST
SHOWERS
SINKS
SUMPS
OAS PIPE OUTLETS
GAS WATER HEATERS
HOODS (commed4
RANGES
., '...• REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSETS trolkq
WASHING MACHINES
WOODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury, that I am the property owner or authorised agent of the property owner. I eertUj that to the best of my
knowledge, the luformation submitted in support of this permit application is true and corral. I certify that I will cdmpW with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a perm[. I understand that the issuance of this permit
does not remove the owner's responsibility jar compliance with local, state, or federal laws regulating construction or envi ronmental laws.
I further agree to hold harmless the City of Federal Way as to any claim pacluding costs, expenses, and attorneys' fees incurred to the
investigation and defense of such otainy, 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 information supplied to
the city as a part of "Is application. -
SIGNATURE:
o NEW o ADDITION
o ALTERATION
o REPAIR a TENANT IMPROVEMENT
BUILDMG SHELL ONLY?
o YES ONO
BASIC PLAN?
a YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
a YES
a NO
NEW ADDRESS REQUIRED?
G YES o NO
UP /SEPA /SU?
o YES
a NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED?
a YES
o NO
Bulletin #100 — January 1, 1008 Page 2 of 4 k\HandoutsTermL , li:ation