09-104269f
C."Or A w� - / 0
Fed'W�EEIDPERMIT
COMMUMN A9VKOPMW SERVICES SF MF CO ME EL PL DE E '�P
33325 AV8U7 2 B F SAOXUT2H 53 • 6PO B�4 60 9 V ?-20OAPPLI CATI O N p
j
u wm.dtuol%d�erna1unumm
The foliolb�►� i W 4&99 p gdH _ omplete application will not be accepted. Please print legibly (in ink) or type.
` r 2 �}Y� c
PROPERTY • •
SITE ADDRESS 1._��L(�L'F3 . ;;71>2 � " - Z� p SUITE /UNIT
ASSESSOR'S TAX /j LLq v��1 0 � - � Z r6 LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
("ued` upmete ~for UVOw Wd dawrWWO
PROJECT •• •
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING N'kIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlg)
PROJECT NAME (Name of Business or Owner Last Namel CAA Ciw 1 rPIrmi SK-M& On.
PEOPLE •• •
PROPERTY
OWNER
NAM
PRIMARY PHONE
( _
OFFICE PHONE
MAILING ADDRESS
CITY, STATE, ZIP
E -MAIL ADDRESS
CONTRACTOR
0
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
COMPANY NAME
AI PLICANT NAME
APPLICANT NAME
OFFICE PHONE
PHONE
yg 7&6q I
MAILING ADDRFM
( -
CELL PHONE
MAILING ADDRESS
ITY, 3TATE, ZIP
PC)
-
-
[fY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE
FAX NUMBER
Am2rx-ia
( ) -
CONTRACTOR'S REGISTRATION NUMBER
EXPIRATION DATE
E-MAIL ADDRESS
S. I
)a;&=Y
C,QMPANY NAME
AI PLICANT NAME
OFFICE PHONE
Inc
PHONE
yg 7&6q I
MAILING ADDRFM
CRY; -STATE, ZIP
CELL PHONE
Y
-
RELATIONSHIP TO PROJECT
FAX NUMBER
,[]Architect ❑ Tenant ❑ Agent Other C 1 %�i'
(
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
PROPOSED USE
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK 4 Lt iaeD
SPRIEKLERED BUILDING? A tES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
(Wr)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
FIRST
COMPRESSORS
FURNACES
RANGES '
SECOND
GAS LOG SETS
REFRIO. SYSTEMS
o NO
THIRD
a YES a NO
UP /SEPA /SUP
ADDITIONAL FLOORS (DESCRIBE)
a NO
PLATTED LOT?
a YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
a YES
a NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
6
TMmm
'n AL
MALSaemroer
TOTAL rsoroeseOr
Toratsr
"NEW HOMES ONLY"'' NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate. number of each type of fudune to be installed or relocated as part of this project. Do not include existing fu Lures 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 Icommrdq
COMPRESSORS
FURNACES
RANGES '
DUCTS.
GAS LOG SETS
REFRIO. SYSTEMS
BATHTUBS (or ub /shaasc comma
LAVS (s�tbroom
URINALS MISC (Describe(
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS Irossq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES .
HOSE BIBBS
SUMPS
o YES
I Bert{ fy under penalty of perjury that I acre the property owner or authorised agent q j the property owner. I cart{ jy that to the best of my
knowledge, the information submitted in support of this permit application is true and correct. I cer ft that I will comply with all applicable
City of Federal Way regulations pertaining to the work authorised by the issuance of a permit. I understand that the issuance of this permit
does not remove the owner's responsibility for compliance with !seat, state, or federal laws regulating conduction or environmental mental laws.
I further'agres 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 clainQ, which may be made by any person, including the undersigned, and filed against the city, but only
when such claim arises out q f the reliance of the city, including its officers and employees,' upon the accuracy of the information supplied to
the city as apart of this application.
SIGNATURE.
o NEW o ADDITION
a ALTERATION
a REPAIR q TENANT IMPROVEMENT
BUILDING SHELL ONLY?
a YES a NO
BASIC PLAN?
a•YES
a NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
o NO
NEW ADDRESS REQUIRED?
a YES a NO
UP /SEPA /SUP
o YES
a NO
PLATTED LOT?
a YES o NO
DEMO PERMIT REQUIRED?
a YES
a NO
Bulletin #100 — January 1, 2008 Page 2 of 4 MandoutsTennit Application