07-104551cm m
Federal way PERMIT
n:OMMUNrl' +DEVELOPMENf SERVICES AUG
1 6 l•' ` SF MF CO ME EL PL DE E P
5332FEDERAL AVENUE AY, A 98063 971 9715 _ LI GATI O N
FEDERAL WAY, WA 98063 -9718 /�
253- 835 -2607• FAX 253 - 835- 2609Q� M F �' EA
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The following is requure d information - an incomplete application will not be accepted. Please print legibly (in ink) or type.
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ew � L �ovl co V y
(Ad h xP .w PM.jb� lengthy 1e9 d—dPd W
PROJECT •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ELECTRICAL ❑ ENGINEERING ❑ FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on
PROJECT NAME (Name of Business or Owner Last Name) avo � 1 U b o v-) . C o n ` f , v-
0
PEOPLE INFORMATION
PROPERTY
OWNER
CONTRACTOR
corn or w,d rago
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
PRIMARY PHONE E -MAIL ADDRESS
I l� ) Z
NAME
Pe CW 19.27.095:
Le iq}brmation is required (jprgject value exceeds $5.000
MAILING ADD
CITY, SINIE. ZIP
/PHONE
l )
EXISTING ASSESSED /APPRAISED VALUE
SPRINKLERED BUILDING? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN
SEWER SERVICE PROVIDER ❑ LAKEHAVEN
PROPOSED USE Q
VALUE OF PROPOSED WORK ® 0
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
r.
PROJECT OO•
AREA DESCRIPTION
AREAS
EXISTING
. FT.
PROPOSED
89. FT.
TOTAL
S . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
o NO
THIRD
❑ YES ONO
UP /SEPA/SU?
ADDITIONAL FLOORS (DESCRIBE)
❑ NO
PLATTED LOT?
❑ YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
m®rma
vsoroem
rore�,
rornce�rnvo er
mru,rrmrosm sr
roru.sr
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture xture 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 )commema
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS iorl b /Shower Com j
LAVS )BMhfOml, Smke)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS ribikU
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
❑ YES
I certify under penalty of perjury that the igformatton furnished by me is true and correct to the best 4f my knowledge, and further, that I
am authorized by the owner of the above premises to perform the nark for which the permit application is made. 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, inclu he undersigned and filed against the City of Federal Way, but only where such claim
arises out of the reliance of the city, including re and employees, upon the accuracy of the irtformation supplied to the city as a part of
this application. (%�
NAME /TITLE DATE 8 , / `� � 0 -t
(Signature) mile)
RELATIONS OJECT O Owner ❑ Agent oelcontractor o Architect ❑ Other
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
❑ YES o NO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
o NO
NEW ADDRESS REQUIRED?
❑ YES ONO
UP /SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES o NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
Bulletin #100 —April 2, 2007 Page 2 of 4 MHandoutsTerinit Application