08-102516"OF -
RE ED
❑ MECHANICAL
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Federal Way
1L
COMMUNITY DEVELOPMENT SERVICES
MAY 21 ROFRMIT
SF MF
CO ME EL PL DE E F
33325 - Pa AVENUE SOUTSOUTH 9718
FEDERAL WAY O 9 9 71 718
253-835-2607- FAX 253-835 2609
APPLICATION
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CITY OF FEDERAL WAY
't IVFPA 3' ("7-002)
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Thefollowing is required
CDS
informatio na incomplete application will not be accepted. Please print legibly (in ink) or type.
SITE ADDRESS ® 10 3 4 H % JT P (k C � �.� SUITE /UNIT # )Ju. C� NJc
ASSESSOR'S TAX /PARCEL # //�� PLOT SIZE (sfi
LEGAL DESCRIPTION /e.a. Acme Estates. Lot 11 r etra ato down USA ~ �� u � kA,'ti C
(Attach se~ page for Iengthy legal desc,iptloN
• • • •
TYPE OF PERMIT
❑ BUILDING ❑ PLUMBING
❑ MECHANICAL
MAILING ADDRESS /� �Y�
OA ��/ ®
4 Mal
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING XFIRE
PREVENTION SYSTEM
PROJECT DESCRIPTION
(Provide detailed description of work included on this
"
ermtt only)
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't IVFPA 3' ("7-002)
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PROJECT NAME (Name of Business or Owner Last Namel (.:,> a r6t
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME � � �� �
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PRIMARY PHO E
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MAILING ADDRESS /� �Y�
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4 Mal
E -MAIL ADDRESS
COMPANY NAME F) � S�.ms
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05E PHONE p - 98()
MAILING ADDRESS 6
TSTATE.
a 3o 2
ELL PHONE -
C OF FEDERAL WAY BUSINESS LICENSE NUMBER E•PI. EXPIRATION DATE
19-97-00005'r-1--00-6z- 10-13, Zo S
FAX NUMBER
(d53) qa6 -- -093,96
CONTRACTOR'S REGISTRATION NUMBER E IRATI DATE
01
E -MAIL AD RESS
au it s l-1h �� r
COMPANY NAME
i R s
APPLICANT NAME
carn Nul I
OFFICE PHONE
( ) %0 - (88
NW.LING ADDRESS
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CITY. STATE. ZIP /�
R 2
/CELL PHONE
( ) -
RELATIONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ther es/ R-
FAX NUMBtE�Rr�I `/� �'y
W5319-6 -(D -a?35
NAME
es AA
PRIMARY PHONE
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E -MAIL ADD S ( - ^
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NAME
Per RCW 19.27.095:
Lender information is required ifproject value exceeds $5,000
MAILING ADDRESS
CITY, STATE, ZIP
PHONE
EXISTING ASSESSED /APPRAISED VALUE $
SPRINKLERED BUILDING?
(YES ❑ NO
WATER SERVICE PROVIDER
>LAKEHAVEN
SEWER SERVICE PROVIDER
❑ LAKEHAVEN
MW
PROPOSED USE
VALUE OF PROPOSED WORK 2-7,01-1
FIRE SUPPRESSION SYSTEM PROPOSED /REgUIRED? yeyES ❑ NO
• HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) //``
• HIGHLINE ❑ PRIVATE (SEPTIC)
0
t
AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
FIRST
FIREPLACE INSERTS
HOODS (comme ciaq
COMPRESSORS
SECOND
RANGES
DUCTS
GAS LOG SETS
THIRD
PLUMBING
ADDITIONAL FLOORS (DESCRIBE)
LAVS (BammomSmks)
URINALS MISC (Describe)
DISHWASHERS
DECK (❑ COVERED OR ❑ UNCOVERED ?)
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
GARAGE ❑ CARPORT ❑
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
NUMBER OF FLOORS
EICMENG
PROPOSED
TOTAL
rOTAL EXI"WO SF
TOTAL PROPOSED SP
TOTAL,
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
FIXTURES
Indicate number of each type offixture 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 (comme ciaq
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (orTub /Shower Combo)
LAVS (BammomSmks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rrmieo
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I cert(fy 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 fled 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
Property Owner and /or Authorized Agent
FOR 4PFIGE 419E,PJL7C
.a 7,,
o NEW o ADDITION o ALTERATION a REPAIR o TENANT IMPROVEMENT
BUILDING SHELL ONLY? o YES o NO BASIC PLAN? a YES o NO
ZONING DESIGNATION CHANGE OF USE? o 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 o NO
Bulletin #100 — January 1, 2008 Page 2 of 4 kU- Iandouts\Permit Application