08-101845e
CITY OF ""' E ` E T V D
Federal
PERMIT SF MF CO ME EL PL DE EN�
COMMUMTYDEVELOPMENT SERVICES
325 8� VZNUESOUTH•POBOX9�1jQ� 1 s Zoo PPLICATION
FEDERAL WAY, WA 98063 -9718 A - _- -
253 - 835 -2607• FAX 253- 835 -2609
wu� citygftederahwdu. mtu
ITY OF FEDERAL WAY
The follow C ng is required igfarpation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS 17 Z7 S 3 ( S FEDERAL WAY WA 98Q94UNIT #
ASSESSOR'S TAX /PARCEL # 0— 2 - _ L L LOT SIZE (sf 2 S
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page for lerigthy legal descriptloN
PROJECT • •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING A FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description o f work included on this 12ermit onl
FIRF SPR1H1CI F2 -TFHAN f IP1PRnV F M E K I I BASEMEMT REWORK
YKVJY:l; -1- 1vAML' �lvame OJ t3usiness Or owner Last. rvurnq l v VI 11
PEOPLE •' •
PROPERTY
0 OWNER
CONTRACTOR
Dw,
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
R
PRIMARY PHONE E -MAIL ADDRESS
T NAM SCRULZE (4Z )9Z7
NAME
NIALender
Per RCW 19.27.095:
igformation is required (f project value exceeds $5,000
MAILING ADDRESS /A
CITY, STATE, ZIP
PHONE _
EXISTING ASSESSED /APPRAISED VALUE
RSPRINKLERED BUILDING?
)(YES ❑ NO
WATER SERVICE PROVIDER
❑ LAKEHAVEN
SEWER SERVICE PROVIDER
❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? YES ❑ NO
• HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
• HIGHLINE ❑ PRIVATE (SEPTIC)
r
AREA DESCRIPTION
EXISTING
s . FT.
PROPOSED
s . FT.
TOTAL
S . FT.
ASEMENT
S2 /j
S148
" ,�
�Z4.g
FIRST
GAS LOG SETS
REFRIG. SYSTEMS
D NO
SECOND
3300
❑ YES
D NO
THIRD
N A
ADDITIONAL FLOORS (DESCRIBE)
A
/��
DECK (❑ COVERED OR El UNCOVERED?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
EXISTM
rxorosw
�
ecrzaxomsr
TOTAL PROPOSED Sr
"NEW HOMES ONLY** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
E FIXTURES
Indicate number of each type of fixture to be installed or relocated as part of this project. Do not include existing factures to remain.
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (orT b /Sb— COmbo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
FANS
GAS WATER HEATERS MISC (Describe)
FIREPLACE INSERTS
HOODS (Commercial)
FURNACES
RANGES
GAS LOG SETS
REFRIG. SYSTEMS
LAYS (Bathroom Sinks)
URINALS MISC (Describe)
RAINWATER SYST VACUUM BREAKERS
SHOWERS WATER CLOSETS (Toilet)
SINKS WASHING MACHINES
SUMPS
I certVy under penalty of perjury that I am the property owner or authorized agent of the property owner. I certVy that to the best of my
knowledge, the ir(forntation submitted in support of this permit application is true and correct. I certVy 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 irifor nation supplied to
the city as apart of this application.
SIGNATURE:
Owner
D NEW o ADDITION D ALTERATION
BUILDING SHELL ONLY? ❑ YES D NO
ZONING DESIGNATION
NEW ADDRESS REQUIRED? ❑ YES ❑ NO
(PLATTED LOT? ❑ YES o NO
❑ REPAIR ❑ TENANT IMPROVEMENT
Bulletin #100 — August 16, 2007 Page 2 of 4 Mandouts)Permit Application
BASIC PLAN?
D YES
D NO
CHANGE OF USE?
a YES
D NO
UP /SEPA /SU?
DYES
D NO
DEMO PERMIT REQUIRED?
❑ YES
D NO
Bulletin #100 — August 16, 2007 Page 2 of 4 Mandouts)Permit Application