07-103089OF • LIT-
CITY
D
Federal Way RECEIVED
SF MF CO ME EL PL DE EN"�F?
COMMUMJY DEVELOPMENT SERVICES
333258TMAAENUESOA 980639718 (�' o 24�PPLICATION
FEDERAL WAY. WA 98083 -9718 1 � /
253-835.2607• FAX 253.835 -2609
wwwx.a ollMerohmu.bTY OF FEDERAL WAY
The following is req * ftft%@p9"V, an incomplete application will not be accepted. Please print legibly rtn ink) or type.
PROPERTY INFORMATION
L
SITE ADDRESS 12 5 �` 7 1 / l SUITE/UNIT A
ASSESSOR'S TAX/PARCEL # a - 0 C) LOT SIZE (Sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
4Wn * wP-aW P?w.- LMdW Wq.L d -1Wa01V
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL �FIRE ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description qf work included on this vermit ord
L. � (zA/ L, s alca,,.t-._ S,vw -Ec w- w vAi - --7 -s,- � Ls I P-,,e,,dJ 3 - -
PROJECT NAME (Name of Business or Oumer Last Namel 'Z l 4J ^ y- —e S S
PEOPLE INFORMATION
PROPERTY
OWNER
V
Of
d
111154
PROJECT
CONTACT
LENDER
EXISTING USE
NAME ` _ 1
'-�.� ./
��
( //fir /� ,/�,� ^
4c) VK0, l
PRIMARY PHONE
( -
MAILING ADDRESS
CITY. ST ZIP c,� j ^J Qj ,
Je�(.� Q r 1 � 1 c.�T
CELL PHONE +�
u.5i ,
CITY, STATE. ZIP
E-MAIL ADDRESS
COMPANY NAME
APPLICANT NAME
Xr, S C cr1 n W
OFFICE PHONE
(35-3 ) $'-75
- 301 b
MAI G ADDRjE�S�S.��% G;
T 3939
CITY. ST ZIP c,� j ^J Qj ,
Je�(.� Q r 1 � 1 c.�T
CELL PHONE +�
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
CON[RACT WS REGISTRATION NUMBER
EXPIRATION DATE
E -MAIL ADDRESS
�(CECIliL- SS '1 \�
0610 2-C
�ir2c0,'AA.J0CC^AC4-S�
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
F,,P -C eCJ tj �--J
PHONE
La 3 ) 515 - 3ol to
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect ❑ Tenant ❑ Agent ❑ Other
(;35:3 ) �;l S - 3 G3S
NAME PRIMARY PHONE E -MAIL ADDRESS
NAME
Per RCW 19.29.095:
Lender igformation is required (fproject value exceeds $5.000
MAILING ADDRESS
CITY. STATE. ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE
SPRIN LERED BUILDING? V YES ❑ NO
PROPOSED USE
VALUE OF PROPOSED WORK $ 4506'
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
1d S
ALI'�
9
PROJECT •••
AREA DESCRIPTION
AREAS
EIQSTITiG
FT.
PROPOSED
SQ. FT.
TOTAL
SQ. FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
GAS LOG SETS
REFRIG. SYSTEMS
THIRD
CHANGE OF USE?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
UP /SEPA /SU?
❑ YES
DECK (❑ COVERED OR ❑ UNCOVERED ?)
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
GARAGE ❑ CARPORT ❑
o NO
NUMBER OF FLOORS
8E®77LIG
M.
Tarwt
TOTALSMMMSP
ToTAr.PROPO®8P
TOTALer
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number gjeach type off fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
of Mechanical Work $.
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WrM APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (co rejai)
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS 1.,T b /sh..combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (sath—SWI.)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS [1b& -tj
SINKS
WASHING MACHINES
SUMPS
BUILDING SHELL ONLY? ❑ YES ❑ NO
I cert(fy under penalty of perjury that the ir4formation furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized by the owner of the above premises to perform the work for which the permit application is made. 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 doVnse 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 igformation supplied to the city as a part of
this application.
NAME /TITLE
4 (Signature)
RELATIONSHIP TO PROJECT o Owner o Agent
o Architect o Other
h, Lo
FOR OFFICE USE ONLY
❑ NEW o ADDITION
o ALTERATION
o REPAIR Q TENANT BEPROVEMENT
BUILDING SHELL ONLY? ❑ YES ❑ NO
BASIC PLAN?
o YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED? o YES o NO
UP /SEPA /SU?
❑ YES
❑ NO
PLATTED LOT? ❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
o NO
Bulletin #100 - January 1, 2007 Page 2 of 4 k\HandoutslPermit Application