08-102513r. s C
C,TYOF �C,��.VED —
Federal Wa� VR+ PERMIT
COMMUNITY DEVELOPMENT SERVICES SF MF CO ME EL PL DE E FP PO 33325 8. AVENUE 63971 21200aAPPLICATION -
FEDERAL WAY, WA 98063 -971�I� -
253- 8352607• FAX 253- 835 -2609
CITY OF FEDERAL WAY
The following is required iIation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS ,-qOIO --3LjWii-j ST' rPdP ra I (Joy, LO A
ASSESSOR'S TAX /PARCEL # 2 —1— a- A— V _LL - a d 5z L
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
1
SUITE/UNIT # &L' l kAS
LOT SIZE (f)
AS
'C�." A-
(ALro[h s p kUA page for L gduy Lyd d-,c pdoN —
PROJECT • ' •
TYPE OF PERMIT ❑ BUILDING
❑ PLUMBING
❑ MECHANICAL
CnY. ,FATE. O�"rI e O U07.71
!
❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING KFIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Pro1uide detailed description of work
included on this
permit on[ul
L
511," etLAS C SFS) \,J.'k�
A,5A,II T
t.�-e� 5j c Vj""kcr
54.5 epu V?I�C'
`aC P � ti Q(
rv. c c�, (/n
etu oy -(7Gh a w r` ll
*eFA4_1. i — )
a IAcf 1l. - C J't + F�f� er, I w'C(" - 5 F S L d,- I I 5+z;I r` - L, terk &I -ALLY & " .s4, dd
Y-2 3 t7 C : •n oc it 1 �
PROJECT NAME (Name of Business or Owner Last Name) y a iota
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
Siam,// �1 fion
PRIMARY PHOPJE
(a) a O
MAILING /vy
(0® / / �/ AV, /VC
CnY. ,FATE. O�"rI e O U07.71
!
E -MAIL ADDRESS
COMPANY NAME
S Fire- S s+e.ms Inc.
APPLICANT NAME
a- m es V u I
OFFICE PHONE
(oa5) aco 19810
MAILING ADDRESS
E
CITY, STATE. ZIP
Tcu6ma -tU14 qgq2,14
CELL PHONE
( ) -
CM OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE
- - 0000s� 00 -64- IQ 131 0 8
FAX NUMBER
(953) 926 - -c9�6
CONTRACTOR'S REGISTRATION NUMBER E IRAT[ DATE
(�l�'4lrt S 1 11 a 0�
E -MAIL AD RESS
II s iA�i . C i
COMPANY NAME
APPLICANT NAME
a IVU I (
OFFICE PHONE
( ) %G (98
N—WLING ADDRESS
-
cnY, STATE, ZIP
Q A 99112
CELL PHONE
( ) -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ther �/ h .a�
FAX NUMBERr�
(�,5j )726 -1?35
1k
NAME PRIMARY PHONE E -MAIL ADD S
�J Ccm PAS /V a/ / _ (a53) % - I wan tit
NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
MAILING ADDRESS
CITY. STATE, ZIP
PHONE
PROPOSED USE
so
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORKv$ ,L� U 3. C G
SPRINKLERED BUILDING? ('YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? )BYES ❑ NO
WATER SERVICE PROVIDER >Q AKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) )e
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
WATER CLOSETS tT acp
SINKS
WASHING MACHINES
FIRST
SECOND
o NEW o ADDITION
THIRD
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
ADDITIONAL FLOORS (DESCRIBE)
BASIC PLAN?
a YES o NO
ZONING DESIGNATION
DECK (D COVERED OR ❑ UNCOVERED ?)
CHANGE OF USE?
❑ YES o NO
GARAGE ❑ CARPORT ❑
o YES o NO
UP /SEPA /SU?
NUMBER OF FLOORS
FJ(LSTU40
PROPO9RO
TOTAL
TOTAL MM"INO SF
TOTAL PROPOSED SP
TOTAL 5F
"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.
MECHANICAL
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 ICommerctaU
COMPRESSORS FURNACES RANGES
DUCTS GAS LOG SETS REFRIG. SYSTEMS
PLUMBEVG
BATHTUBS (or Tub/Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom SmkS)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS tT acp
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 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, orfederal 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 information supplied to
the city as a part of this application.
SIGNATURE:
DATE
� /U I/
Property Owner and /or Authorized Agent
FOR 6FFIOaE SSE C�It(I.Y
o NEW o ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
a YES o NO
ZONING DESIGNATION
CHANGE OF USE?
❑ YES o NO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU?
o YES o NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES ❑ NO
Bulletin #100 —January 1, 2008 Page 2 of 4 kWandoutsTermit Application