08-105582CRY or A j- ! 4/ 5 5 !J G
�' %-x 1,� PERMIT
CDYANNI7YD"mP SF MF CO ME EL PL DE E F
333 25 8TM AVBM/B SDU 9718 253- 835 -460 T T
FSDBRAL WAY, WA 98063
?53�B3 -260 9 � 1 g 1A P P P C AT I O 2S3-935-2607- FAX �
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The following is rollIfI 92aPL incomplete application will not be accepted. Please print iegibbj (in ink,) or type.
SITE ADDRESS V ° 11 UITE /UNIT 9
6 _
ASSESSOR'S TAX /PARCEL • g O� L Q - � Q
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
Alo
TYPE OF PERMIT 0 BUILDING 0 PLUMBING 0 MECHANICAL �D�R
O DEMOLITION ❑ ELECTRICAL 0 ENGINEERING jF� �
DDn.rrrrm :.a....;s ,. «:..j
PROJECT NAME (Name of Business or Owner Last Name1
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
NAME _
APPLICANT NAME
PRIMARY PHONE
MAILING ADDRESS
CITY, STATE, ZIP
E-MAILADDRZSS
COM E
APPLICANT NAME
APPLICANT NAME
OI+FICE ONE
rent
e6
) -
MAILING ADDRESS
RELATIONSHIP TO PROJECT
, ZIP:
CELL PHONE
D o 92 X
w
OF FEDERAL WAY BUSIN&43 LICE
NUMBS EXPIRATION T
FAX IMMER
�.- c� - 03
3 —rso — C.�
( ► -3
CONTRACTOR% RFOi8TR,% NUNNZR,
I Z PMATION DATt
E-MAILADDRESS
Q
COMPANY NAME
APPLICANT NAME
OFFICE PHONE
CITY, STATE, ZIP
PHONE
( )
MAILING ADD
CITY, STATE, ZIP
CELL PHONE
RELATIONSHIP TO PROJECT
FAX NUMBER
0 Architect o Tenant o Agent O Other
lilt
NAME
per RCW 19.27.096:
Lendw ft&muWon is mg"-M VOW WO vales =can& i5j000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
( )
EXISTING USE PROPOSED USE /n
EXISTING ASSESSED /APPRAISED VALUES VALUE OF PROPOSED_ WORE
L
SPRINKLERED BUILDING? D YES ONO FMZ SUPPREMON SYSTM PROPOSED /RBQUMM? O YES ONO
WATER SERVIC* PROVIDER 0 LAKEHAVEN O HIGHLINE O TACOMA O PRIVATE (WELL)
SEWER SERVICE PROVIDER 0 LAKMAV39N O HIGHLINE D PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
8 . FT.
PROPOSED
SQ. FT.
TOTAL
SQ, FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES
SECOND
OAS LOG SETS
REFRIG. SYSTEMS
ONO '
THIRD
a YES a NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
o NO
PLATTED LOT?
a YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED?)
DEMO PERMIT REQUIItED?
a YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
msrao
rsoroam
rarI&
ror cmwMIG"
ror."isorossosr
raraar
"NEW HOMES ONLY"" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate. number of each type of fixture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
AIRM"CAL
Value of Medmical Work $ (A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITHAPPLIC,ATIONJ
AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS �cdq
COMPRESSORS
FURNACES
RANGES
DUCTS.
OAS LOG SETS
REFRIG. SYSTEMS
BATHTUBS (arnb /sbo ar Cml LAVS (Bad.. ab*y URINALS MISC (Deacnbe)
DISHWASHERS RAINWATER SYST VACUUM BREAKERS
DRINKING FOUNTAINS SHOWERS WATER CLOSETS fra"
ELECTRIC WATER HEATERS SINKS WASHING MACHINES .
HOSE BIBBB SUMPS
Z certo under Penally Rupp% that I am the property owner or authorized agent, q% the property owns. r caw& that to the best of my
lawwWgo, the bV%rmation submitted in support utf this permit application is true and correct. r certft that Jr will cmxp(y with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. r understand that the issuance of this permit
doss not remove the owner's responsibility for cenpiiance with local, state, or federal laws roguelattng construction or environmental laws.
Z f urther agree to hold harmless the City of Federal Way as to any claim (incl costs, expenses, and attorneys' fees incurred in the
investigation and defense of such eiahN, which may be made by any Person, acting the undersigned, and flled against the city, but only
where such claim arises o the reliance of the city, including its o�ie�and enplogees, upon the accuracy of the information supplied to
the etig as apart of this. a�n. / / i / /-901
SIGNATURE:
avc
o NEW a ADDITION
a ALTERATION
a REPAIR a. TENANT LMPROVEMENT
BUELDING SEMLL ONLY?
a YES ONO
BASIC PLAN?
o. YES
a NO
ZONING DESIGNATION
CE[ANGE OF USE?
a YES
ONO '
NEW ADDRESS REQUIRED?
a YES a NO
UP /SEPA /SU?
o YES
o NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIItED?
a YES
a NO
Bulletin #100 — January 1, 2008 Page 2 of 4 MandoutMermit Application