08-105177�-q& RECEffEp
Fedlwaiwa, ocl 30 2ooa PERMIT
COMMEN IYDAMUD A WSRIMP s
99s256�AVExDESar1H•POeaXS�, OF FED , CATION
FEDERAL WA WA 98089.8718
259-895 -2807 : �
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VwfoUowbW is nequir d iq orntadon -an bumniplebe application edit not be accepted. .Pleaw print loyft (in 6W or too.
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ASSESSOR'S TAXMARCRL * -7 Z -a -a U Q_ - Q —1 -a 5 1 Z
Surrag ' A —
LDT SZE (sn '—'
LEGAL DESCRnvnON (e g. Acme F.s , Lot 1) g1]o e.\ n 9 ReFCfl D I'll 51 01J
fAk.h PW.>l bMft >Vd a--ou -u b( ouc . 1 Z LoT / 74 ( 8
TYPE OF PERMIT ❑ BUn DI NG ❑ PLuwmmG ❑ MSCHANICAL
❑ DUWLMON ❑ RLBCTRICAL ❑ ZKOINERMG�FIItE PRXvXmTION SYSTEM
PROJECT DESCRIPTION (Prowde dewded dewnlpdon cif work included on this a mit onlu)
pop■ PEOPLE INFORMATION
10
APPLICANT
NAME
PRIMARY PHONE
FP-1a N k-- 5St CF} METE'-
( ) -
MAUINGADDRESS
CRY. STATE. ZIP �� Oh
A
E- MAII.ADDRI_S.S
l✓ 5 tr
V
COMPANY NAME
To tit
APPLICANT NAME
OFFICE PHONE
(z5_v B41-76&
MAWNC ADDRESS
4D A r,3 A ✓6 a.
CRY. Smm ZIP
e w(q q831
CELL PHONE
) - 54
CRY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPUUMON DAZE
FAX NUMBER
(253) 241 -4450
(OWFgACrO" VaPCISTJUMON
ZZPUtATM DATE
E- MA%ADDRESS
W A S 14X- z P
o- o- Zo1 oyj
1�
COMPANY NAME
o t£ SPAm
APPL CANT NAME
1-7PP PtYDM'q rj
OFFICE PHONE
(7-55 841 - 760 G
MAUINGADDRESS
-37-08 e✓ c ,
cm, STATE. ZIP
w 9
CE"PHONE
tZS 9 88' - ?-4
RELAMONSMP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent Other F-10-9ZErw 'I awmeAc
FAX NUMBER
94A 4+50
.NV7-1
NAME PRIMARY PHONE E-MAL "REM
NN YOM (2 t- G� Nsr
NAME
Per RCW 19.27.09&:
LetiWw b#brmatfan is r=Zgdred V o*ea maw exceeds $5 000
MAHINGADDRESS
CRY. STATE. ZIP
PHONE
RKWI NG ASSESSED /APPRAMED VALUE $
SPRDnMLXRED BURDI NG? YES ❑ NO
WATER SERVICS PROVIDER LASEHAVEN
SEWER SERVICE PROVIDER 11 VffiN
PROPOSED USE i =es 1 D c NCB
O
VALUE OF PRt1POBEa $ �\ 1 000 `-
FIRE SDPPRESION SYSTEM PROPOSED/REQUMED? XS ❑ NO
❑ ffiGELUM ❑ TACOMA ❑ PRIVATE (IMM)
13 BIGEmmm ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
SQ, FT.
TOTAL
99, FT.
BASEMENT
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT III�ROVF.it�M'
FIRST
BUILDING SHELL ONLY?
❑ YES ONO
SECOND
BASIC PLAN?
❑ YES
137 5'
THIRD
CHANGE OF USE?
ADDIIIONAL FLOORS (DESCRIBE)
❑ NO
NEW ADDRESS REgUIRED?
❑ YES ❑ NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
UP /SEPA/SU?
❑ YES
❑ NO
GARAGE '6�/ CARPORT ❑
/,
❑ YES ❑ NO
/ z 2
C OrorecsF
s�
NUMBER OF FLOORS
■eQOSa
Tenet
mrecawanwer
mrecraoro ®er
t7
**NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMAIED SELLING PRICE $
tndtcate number of each fiW 4f (Ldue to be InstaMd or reloeai ed as port c'thls project. Do not W1 ude exLstlrg f fixtures to rema#L
of Mechantoal Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATtrrUBS (-Tub/s&—C-."
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ES7WA7E MUST BE INCLUDED WTM APPLJCA77ON1
EVAPORATIVE COOLERS GAS PIPE OUTLETS WOODSPOVF.S
FANS GAS WATER HEATERS MISC (Descro3e)
FIREPLACE INSERTS
FURNACES
GAS LOG: SETS
IAVS (Bamcoon.q,.
RAINWATER SYST
SHOWERS
SINKS
SUMPS
HOODS r..-.r su
RANGES
REFRIG. SYSTEMS
URINALS
VACUUM BREAKERS
WATER CLOSEIS ab"
WASHING MACHINES
,;—;, q_ MSC (Describe)
F(fzc�- SP94I3
HC—A D S
I ,rti11 under pity of pedwV that I an the property owner or authorised agent qf the property owner. I certo that to the best qf my
Lowrwledge, the bu- mmation sainnteted in support of this permit application is true and co recL I oert}fy that I will comply with ail WOOabfe
City of Fsdwal way regulations pertaining to the work authorised Ig the i— of a permit. I oRderstand that the issuance qf this permit
does net remove the oumm 's regmnsM ty for compliance with focal. state, or federal laws regulating oonstrudian or cnatrorunerhtal laws.
I,jarther agree to hold harmless the C)ty of Federal Way as to any claim $ ncfuding costso expenseso and atlnrneys' fism incurred in the
investigation and dense gf'such cl aim), which stag he made by any persom including the undendwned, and filed against the city, but only
where such claim arises out of the reliance of the city. including its 01cers and employees. upon the accuracy of the Warmation supplied to
the city as a part of this application.
SIGNATURE: 16 1 is P1 I (-f A h7h
VOW min s
,
❑ NEW ❑ ADDITION
❑ ALTERATION
❑ REPAIR ❑ TENANT III�ROVF.it�M'
BUILDING SHELL ONLY?
❑ YES ONO
BASIC PLAN?
❑ YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES
❑ NO
NEW ADDRESS REgUIRED?
❑ YES ❑ NO
UP /SEPA/SU?
❑ YES
❑ NO
PLATTED LOT?
❑ YES ❑ NO
DE KO PERNUT RIDQUM D?
❑ YES
❑ NO
Bulletin #100 — January 1, 2008 Page 2 of 4 WiandoutsTermit Application