08-102512ot -_ 102 -512.
Federal WaRECEIVE9ERMIT r i
COMMUNITY DEVELOPMENT SERVICES SE MF CO ME EL PL DE EN
3332FEDEW AVENUE
WAY, WATH • PO 9718 8 MAY 21 APPLICATION
FEDERAL WAY. WA 980639718 D j /
253- 835 -2607• FAX 253- 835 -2609 /
The followinC4-reYuig-F,,F ,dEid" ilt8AYiete application will not be accepted. Please print legibly (in ink) or type.
o I J 1 l° �i e C Ct I C� �,� SUITE /UNIT # C t "J D LA SCE
SITE ADDRESS s �t
ASSESSOR'S TAX /PARCEL # A— - D LOT SIZE (sj)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ( ara aL ~Town USA (u 6 H OL(S L
(Attach sepAUA page for lengthy legal descrip6oN
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING J FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Prout
� ) I I`Vk V7- I' rt, S,S �
2r,oz) a J C=
detailed description of work included on this permit onlul .
i o Jo t 't c •tee 5 (', n
or "
erf I (Joe
.511 jzaf q L-1 Q dj e if T7 i c,V vt!-r 5 1 v,
PROJECT NAME (Name of Business or Owner Last Ntamel V a ra
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
a7(,—k, fmcdl ,lei actvrdme �- AFpf)3:
•; n 1<�er ��IS er 1Zo0 m
NAME
i_ rCc.
o
PRIMARY PHO E
l Q'�(JY )
_
1 1 IC/O® /� / I Y t / - r
CITY. STATE, O'l2 vi/ � U07,71
E-MAIL ADDRESS
COMPANY NAME
5 Fi (e. S S+ Wis
(1e_.
APPLICANT NAME
_ M es N u
OFFICE PHONE
05) a(o 1990
MAILING ADDRESS
E
CITY, STATE, �ZIP /����j�yy�� ^�
—m c VI 1 c tOlq Z
CELL PHONE
( ) -
CM OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
9- 9 7 - 000055- 0U la 3> o 8
FAX NUMBER
1 (;53) V6 - -aka
CONTRACTOR'S REGISTRATION NUMBER EXPIRAT169 DATE
Mii� I 11 a 0�
E -MAIL AD RESS
it re.
COMPANY NAME
i F� r
APPLICANT NAME
jzz CS ma (
OFFICE PHONE
( ) %(® - (28
LING ADDRESS
CCIY, STATE, ZIP (�
Q l
CELL PHONE
( )
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent Cher es/ n
FAX NUMBER
W'S3 026
NAME
PRIMARY PHONE
(a ),9 -
E -MAIL ADD S
r �+
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 $,
SPRINKLERED BUILDING?
('YES ❑ NO
WATER SERVICE PROVIDER
"HAVEN
SEWER SERVICE PROVIDER
❑ LAKEHAVEN
PROPOSED USE
VALUE OF PROPOSED WORK $ / I ) ❑j C � () 6
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? AYES ❑ NO
❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) /`
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
1K
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
WATER CLOSETS r wa)
SINKS
WASHING MACHINES
FIRST
SECOND
THIRD
ADDITIONAL FLOORS (DESCRIBE)
DECK (❑ COVERED OR ❑ UNCOVERED ?)
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
Exuavio
PROPOSED
TOTAL
70M. E7Q8 WG SF
70rAL PROPOSED SF
TOTAL SF
" *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
0 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.
MECHANICAL
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
BATHTUBS (or Tub /shower 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 (commerc m)
FURNACES RANGES
GAS LOG SETS REFRIG. SYSTEMS
LAVS (Bathroom Smksl
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS r wa)
SINKS
WASHING MACHINES
SUMPS
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 (7lformation 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.
Ifurther 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 irtformation supplied to
the city as a part of this application.
SIGNATURE: DATE
Property Owner and /or Authorized Agent
FIR OFFi(E USE i`.3NLY
o NEW o ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? ❑ YES c NO BASIC PLAN? a YES ❑ NO
ZONING DESIGNATION CHANGE OF USE? a YES o NO
NEW ADDRESS REQUIRED? ri YES ❑ NO UP /SEPA /SU? a YES o NO
PLATTED LOT? o YES o NO DEMO PERMIT REQUIRED? o YES o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 k\Handouts\Permit Application