08-102515cm aF :,,
kderafWay PERMIT -- - - - - --
COMMUNITY DEVELOPMENT SERA 21 2008 SF MF CO ME EL PL DE E FP
33325 D AVENUE SOUTH • 63 9718 j'� A��' T I CATI O N
FEDERAL WAY. FAX 53-8 3 260
253 -835 -2607• FAX 253 - 8352609
0F FEDERAL
The following is require CiDFynation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
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PROPERTY •. •
SITE ADDRESS ® � O r 3 - u I H 44, 5-1. FP_d t? ra SUITE /UNIT # 101 U
ASSESSOR'S TAX /PARCEL # 2- -A- V 4- - D /��`/� LOT SIZE (sfl
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ( ara AG Town USA i , � `(k. I he 0
(Attach sepAak page far lengthy legal descrwtlanl
PROJECT • •
TYPE OF PERMIT
❑ BUILDING
❑ PLUMBING ❑ MECHANICAL
PRIMARY PHO E
❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERING �FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included
`�
n this permit on1
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APPLICANT NAME
a m es P u l l
I C1<WOrk -, `ae r
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i acc uYr Rvlc� wr r 13:
C 1e02
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AP NAME
OFFICE PHONE
( _ - 1 ,2�
MAILING ADDRESS
-
CITY, STATE, ZIP
PROJECT NAME (Name
of Business or Owner Last
FAX NUMBER t�
W.S3 � /qOLIO 'x135
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
1
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PRIMARY PHO E
MAILING
{
1 / OO / I Y t / •
A I
V O ZIP nVI e / /
E -MAIL ADDRESS
COMPANY NAME
� i C_ S S +e AAS
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APPLICANT NAME
a m es P u l l
(653) q a(0 V
MALING ADDRESS I
E
CffY, STATE. ZIP
` K`/ tojq q,?q2,
CELL PHONE
-
I
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER '<PI TION DATE
9- - 00005x- 0U -9Z /a ,3/ 0 9
FAX NUMBER
(03) qa6 - -I93,96
CONTRACTOR'S REGISTRATION NUMBER E IRATI DATE
� a rni+h s> �
E -MAIL RSS
l s l�r
COMPANY NAME p.
`J
AP NAME
OFFICE PHONE
( _ - 1 ,2�
MAILING ADDRESS
-
CITY, STATE, ZIP
NE
CELL PHONE
-
RELATIONSHIP TO PROJECT
C1 Architect ❑ Tenant ❑ Agent Pther /
FAX NUMBER t�
W.S3 � /qOLIO 'x135
NAME
es' AA
PRIMARY PHONE
(d-53)-9z-/990
E -MAIL ADD S
�+ .
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 v Wi.700 -C? D
FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? 111jJi'ES ❑ NO
13 HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) /`
❑ HIGHLINE ❑ PRIVATE (SEPTIC)
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31
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AREA DESCRIPTION
EXISTING
S . FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
FIRST
FIREPLACE INSERTS
HOODS (Comme c ap
COMPRESSORS
SECOND
RANGES
DUCTS
GAS LOG SETS
THIRD
o YES o NO
UP /SEPA /SU?
ADDITIONAL FLOORS (DESCRIBE)
o NO
PLATTED LOT?
o YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
DEMO PERMIT REQUIRED?
o YES
o NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
F.I .M.
PROPOSED
TOTAL.
TOTAL EXISMO SP
TOTAL PROPOSED SP
TOTAL SF
'*NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
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 c ap
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
_ REFRIG. SYSTEMS
BATHTUBS (.,r b /shm- rComho)
LAVS (Bath,00mSnks)
URINALS MISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rroticu
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
o YES
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 responsibilityfor compliance with local, state, orfederal laws regulating construction or environmental laws.
I further 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.
C-.1 . A _
SIGNATURE:
Owner and /or Authorized
o NEW o ADDITION
o ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
o YES o NO
BASIC PLAN?
o 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 kWandouts\Permit Application