05-100688C"
F ,.A Way � ryrynr� yy PERMIT
cOMiEfUNl ✓EVELOPMENT SERVICES r C. �. 1 /. U v J
333258TH AVENUE SOUTH • Po BOX 9778 Q PEDEA WAY, WA 98063 -78
253- 835 -2607• FAX 253- 835 - 2609 / 17 T 0f F L b
p, I C AT I O N
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wwwxftwffederalwau.mm bUILhINP p1-p1,
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The olio is fired i
ormation - an into fete a Iication will not be acce aftd.
Please erint fie ibi in in or tqoe
PRIMARY PHONE
( �j Z-1 O
PROPERTY
• •
cA
SITE ADDRESS -3 A l 3
? A c i F i c HL,-' -f
d:�7
SUITE /UNIT N
ASSESSOR'S TAR /PARCEL #
Q a Z -L Q -4- -
q l -L
LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach sepa..W pc f len9mY legal danoipli -)
E PROJECT INFORMATION
TYPE OF PERMIT O BUILDING ❑ PLUMBING O MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERINGY�,FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed de t'on of work included on this permit only)
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ZF-Pl ArF 6yk1'5 1 1111. aFAO
c A-%';00 J t> P O) r td T 4 4-iLD e Ie i= l ., - ATtz S I Y. T Y H"
� ' TNIe- TEES -1 '
PROJECT NAME (Name of Business or Owner Last Name)
PEOPLE • •
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
NAME
Go L`
PRIMARY PHONE
( �j Z-1 O
MAILING ADDRESS
r
CITY, STATE, ZIP
cA
COMPANY NAME
—
c v �c
APPLICANT NAME
o
OFFICE PHONE
Z5► 21
-96�
MAILING ADDRESS
i O G�
CITY, STATE, ZI
L
VD WA, U5
CELL PHONE
(
-
CITY O FEDERAL WAY BUSINESS LICENSE NUMBER
Z C- -O 1--1 Q L 9 t-; `l -B
EXPIRATION DATE
L 12 /3 /G5
FAX NUMBER
qz5) 821
- 1414
CONTRACTORS REGISTRATION NUMBER (copy of card required with each application)
Co !i4C�F 11�>cILA
EXPIRATION DATE
1 / / _1
COMPANY NAME
MF, AI5 '
APPLICANT NAME
OFFICE PHONE
MAILING ADDRESS I
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ❑ Other (Describe)
C
FAX NUMBER
ME
v %j
PRIMARY PHONE
E -MAIL ADDRESS
G
Per RCW 19.37.095: Lender information is
required (f project value exceeds :$5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED /APPRAISED VALUE $_
SPRINKLERED BUILDING? O YES ❑ NO
PROPOSED USE
VALUE OF PROPOSED WORK $
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
J
M
i
' AREA DESCRIPTION
FMSTING
3 . FT.
PROPOSED
TOTAL
80. FT.
BASEMENT
❑ NEW ❑ ADDITION
o ALTERATION
c REPAIR o TENANT IMPROVEMENT
FIRST
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
SECOND
o NO
ZONING DESIGNATION
THIRD
CHANGE
OF USE?
o YES
FOURTH
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
ADDITIONAL FLOORS (DESCRIBE)
/SEPA /SU ?-
❑ YES
❑ NO
DECK (COVERED ?)
DEMO PERMIT REQUIRED? -
❑ YES
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
�w
Pe°ross°
Tarty.
Tanwsusraau
TOTwPproesosr
Twr
" *NEW HOMES ONLY`* NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
A1F,CH A7CAL oC7
Value of Mechanical Work $ O O —
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (mn b /Sb..,combo)
DISHWASHERS
GAS PIPE OUTLETS
WASHING MACHINES
LAVS(Ba .m sink.)
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
SHOWERS
SINKS
SUMPS
URINALS
VACUUM BREAKERS
GAS LOGS
HOODS (Commercial)
RANGES
GAS WATER HEATERS
WATER CLOSETS (Toney _
DRINKING FOUNTAINS
RAINWATER SYST
HOSE BIBBS
ELECTRIC WATER HEATERS
REFRIG. SYSTEMS
W OODSTOVES
MISC (Describe)
MISC (Describe)
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. 1 further 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 of Federal Way, 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 a part of
this application.
NAME /TITLE Rivnv,n ?9- 6160% NAA M46-f- DATE Q O
ml ITitlrl
RELATIONSHIP TO PRC)(IECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
FOR OFFICE USE ONLY
❑ NEW ❑ ADDITION
o ALTERATION
c REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES ❑ NO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE
OF USE?
o YES
❑ NO
NEW ADDRESS REQUIRED? ❑
YES ❑ NO
UP
/SEPA /SU ?-
❑ YES
❑ NO
PLATTED LOT? o YES ❑ NO
DEMO PERMIT REQUIRED? -
❑ YES
o NO
Bulletin #100 – January 7, 2005 Page 2 of 4 k\Randouts\Permit Application