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07-1048974 cm of FIF-CEIVA Federal way PERMIT COMMUNnYDEVELOPMEWSERVJCESSFP Q 4. 2007 SF MF CO ME EL PL DE EN 33325 8m AVENUE , WA 9 • PO BOX 9718 x, LI CATI O N FEDERAL WAY, WA 98063 -9718 253 - 835 -2607• FAX 253-835'-'26 09Ty O F FED E ty_,cltn e.I@ertiu {g�.c�jt BUILDING DEPT. The following is required irljormation - an incomplete application will not be accepted. Please print legibly (in ink) or type. M PROPERTY INFORMATION SITE ADDRESS ( �j. ��� �� ° LO OJ SUITE /UNIT # ASSESSOR'S TAX /PARCEL # LOT SIZE (s,) LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) (Adach separate page for Lengthy legal description PROJECT • ' • TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION 7❑ ENGINEERING Q'FIRE PREVENTION SYSTEM PROJECT DESCRIPTION (Provide detailed description of work included on this vXit oniu) ru�.�.- - PROJECT E (Name of Business or Ouner Last r E PEOPLE INFORMATION PROPERTY OWNER CONTRACTOR APPLICANT N E UoLk) t i /� ,., OFFICE PHONE ( ul0) M ( PRIMARY PHONE Gov O� 3 J�� JI . �i T ZIP � w ` /] bmRE COMPANY NAME N-k) Luc &l � 1'�Q.,. 1A/PPL C NAM (� 1('� -eAl 1�`jIY ( ) OFFICE PHONE ( ul0) M ( � jJ p - �T V o Uf' ii I t C I /�� 1520 1.©In / �V�. J.�I.VU -\' J ZIP WA 9SIO� CELL PHONE ( ) - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER ill -99 • ( vc� 0"5 . EXPIRATION DATE L FAX NUMBER (2rb ) M I -16ut) CONTRACTOR'S REGISTRATION NUMBER EXPIRATION DATE E -MAIL ADDRESS COjvIPANY NAME Ar'PLINAME OFFICE PHONE - 1 YV 9 ADDRESS S� b c sTATE. ,W— Wb RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant 4ent ❑ Other FAX NUMBER r PROJECT NAME /�� L PRIMARY PHONE E-MAIL nE EADORES CONTACT IA 1 k( D L Y / ( lam/ - ( lV J[ lV��IrilUl/Jl\ 1 �d LENDER NAME Per RCW 19.27.095: ' Lender irtformation is required (f project value exceeds $5,000 MAILING ADDRESS CITY, STATE, ZIP PHONE DETAILED BUILDING •' • EXISTING USE W V'1 Vlf\ PROPOSED USE w EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK $ b (' Of SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHIdNE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) AREA DESCRIPTION EXISTING S . FT. PROPOSED SQ.FT. TOTAL SQ. FT. BASEMENT AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES FIRST FANS GAS WATER HEATERS MISC (Describe) BOILERS —SECOND HOODS (commercial) COMPRESSORS FURNACES THIRD DUCTS _ GAS LOG SETS _ REFRIG. SYSTEMS ADDITIONAL FLOORS (DESCRIBE) DEMO PERMIT REQUIRED? ❑ YES ❑ NO DECK (❑ COVERED OR ❑ UNCOVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS SffiennG rn rarer sffisrnro sr rarer axorosm Sr TOTAL sr •'NEW HOMES ONLY"" NUMBER OF BEDROOMS MATED SELLING PRICE $ rnatcare numDer oj each Type oJJtxuure ro oe utsrauea or retocarea as pan of Lrus projecr. do no[ utcatae exLsrutgJuaures to remain. "CMMCAL LAVS (Bathroom sinks) URINALS MISC (Describe) Value of Mechanic rk (A COPY OF BID OR ESTIMA7E MUST BE INCLUDED W177-I APPLICATION AIR HANDLING UNITS EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSTOVES BBQS FANS GAS WATER HEATERS MISC (Describe) BOILERS FIREPLACE INSERTS HOODS (commercial) COMPRESSORS FURNACES RANGES DUCTS _ GAS LOG SETS _ REFRIG. SYSTEMS BATHTUBS (or9Lb /Shower Combo) LAVS (Bathroom sinks) URINALS MISC (Describe) DISHWASHERS RAINWATER SYST VACUUM BREAKERS DRINKING FOUNTAINS SHOWERS WATER CLOSETS rrotlet) ELECTRIC WATER HEATERS SINKS WASHING MACHINES HOSE BIBBS SUMPS ❑ YES ❑ NO I cert(fy under penalty of perjury that I am the property owner or authorized agent of the property owner. I cert(fy that to the best of mg knowledge, the irtformation submitted in support of this permit application is true and correct. I cert(fy that I will comply with all applicable City of Federal Way regulations pertaining to the work authorized 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 laws regulating construction or environmental laws. I 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, but only where such claim arises out of the reliance of the city, including its officers and employees, upon the accuracy of the igformation supplied to the city as a part of this application. / { SIGNA V / DATE "L v Property Owner and /or AutholIzed Ageiit T ❑ NEW ❑ ADDITION BUILDING SHELL ONLY? ZONING DESIGNATION NEW ADDRESS REQUIRED? PLATTED LOT? ❑ ALTERATION ❑ REPAIR ❑ TENANT DIPROVEMENT ❑ YES ❑ NO BASIC PLAN? ❑ YES ❑ NO CHANGE OF USE? ❑ YES ❑ NO ❑ YES ❑ NO UP /SEPA/SU? o YES ❑ NO ❑ YES ❑ NO DEMO PERMIT REQUIRED? ❑ YES ❑ NO Bulletin #100 — August 16, 2007 Page 2 of 4 k\Handouts\Permit Application