08-101997C F-01 eD
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MY OF – 2— I I /— I !Z�
Federal Way APR 2 '3 "PE IT
COMMUNITY DEVELOPMENT SERVICES Y SF MF CO ME EL PL DE EN FP
33325 8- AVENUE SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063 -97 T O F
253- 835 -2607• FAX 253 - 835 -2t ! ATI O N
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The following is required irtformation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
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SITE ADDRESS _
ASSESSOR'S TAX /PARCEL #
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach separate page jor lengthy Lgal description)
PROJECT INFORMATION
SUITE /UNIT #
LOT SIZE (S, )
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
n
PROJECT NAME (Name of Business or Owner Last Name)
PROPERTY PRIMARY PHONE ^
OWNER R�
,.
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
C PANY N E
a c e, 1 C-
APPLICANT NAME
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OFFICE PHONE
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RESS
CITY, STATE, ZIP
CELL PHONE
CI OF FEDERAL WAY USINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
CA _ o z- ,o�'
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent )(Other C- ry- J&NclLog
(9, (o ) 7a (,-
C TRACTOR'S REGISTRATION NUMBER
C I FF S 9' 7,-3 P V
EXPIRATION DATE
E -MAIL ADDRESS
Pt3 B
MPANY rE
Per RCW 19.27.095.
Lender information is required if project value exceeds $5,000
P CANT NAMEr'
OFFICE PHONE
MAILING ADDRESS
Cc 1 P
CITY, STATE, ZIP
CELL PHONE
12
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent )(Other C- ry- J&NclLog
FAX NUMBER
(7-0(- ) l ;1-G -
9
I PRIMARY PHONE E -MAIL ADDRESS
""A (u (-) 3') - -i o q �
N 7—
NAME
Per RCW 19.27.095.
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE
PROPOSED USE
VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
U
U
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
FIRST
FIREPLACE INSERTS
HOODS (Commerda))
COMPRESSORS
SECOND
RANGES
DUCTS
GAS LOG SETS
THIRD
❑ YES
❑ NO
ADDITIONAL FLOORS (DESCRIBE)
k\Handouts\Permit Application
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
E7LISTaIO
PROP --
TOTAL
7YlTAL ERffiTINO 9F
70TAL PROPOSRD SF'
TOTAL 9F
"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 fixtures to remain.
Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (Commerda))
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (orlub /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom Smks)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS (Toilet)
SINKS
WASHING MACHINES
SUMPS
❑ YES
I certify under penalty of perjury that I am the property owner or authorized agent of the property owner. I certify that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I certify 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 th!,pity, incl its oQicers and employees, upon the accuracy of the irtjormation supplied to
the city as a part of this applies' rt-�
❑ NEW ❑ ADDITION
BUILDING SHELL ONLY?
ZONING DESIGNATION
NEW ADDRESS REQUIRED?
PLATTED LOT?
Bulletin #100 — January 1, 2008
IV —ate o4�
Owner and /or Authorized
❑ ALTERATION
❑ REPAIR ❑ TENANT EM PROVEMENT
❑ YES ❑ NO
BASIC PLAN?
❑ YES
❑ NO
CHANGE OF USE?
❑ YES
❑ NO
❑ YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO
❑ YES ❑ NO
DEMO PERMIT REQUIRED?
❑ YES
❑ NO
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k\Handouts\Permit Application