08-102514RECEIVES
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Fed
PRIMARY PHOrIE
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Federal Way
Y MAY 21 2003 PERMIT
SF MF CO ME EL PL DE EN�
COMMUNITY DEVELOPMENT SERVICES
33325 8TM AVENUE SOUTH • PO BOX 9718 A/� pp TT I CATION
FEDERAL WAt 3 FE®ERkW�Y"
253 835 2607 3 3
COMPANY NAME
S Fire- S S+e
The following is require0f§ -ation - an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY • •
MAILING ADDRESS
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CITY, STATE, ZIP
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CELL PHONE
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1
SITE ADDRESS ® 10 -- -1 Lj H +11 ST- ECd C CrA 1 (� �t �.��
SUITE /UNIT # u
ASSESSOR'S TAX /PARCEL # -a -t a- —L 0— 1� - -q- 0 o�
LOT SIZE (sfl
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LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) & arq aL / C�'Wn ✓ S
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(Attach se page f r lengthy legal desc,iptioN
APPLICANT NAME
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PROJECT • •
LING ADDRESS
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
CELL PHONE
( ) -
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of u)ork incl ed on this permit only/
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NAME
Per RCW 19.27.095:
Lender information is required if project value exceeds $5,000
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USA
PROJECT NAME (Name of Business or Owner Last Name) ✓ i �W�
PROPERTY
OWNER
CONTRACTOR
APPLICANT
PROJECT
CONTACT
LENDER
EXISTING USE
NAME
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PRIMARY PHOrIE
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MAILING
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CITY. STATE. ��/ Q
E -MAIL ADDRESS
COMPANY NAME
S Fire- S S+e
APPLICANT NAME
OFFICE PHONE
05 3) oo 990
MAILING ADDRESS
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CITY, STATE, ZIP
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CELL PHONE
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CM OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIR AMON DATE
/9-97-00005,49--00-64- ra 3 o 9
FAX NUMBER
(;.5-3) V6- -09
CONTRACTOR'S REGISTRATION NUMBER E IRATI DATE
4E D -MAIL A RESS
COMPANY NAME
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APPLICANT NAME
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OFFICE PHONE
c - l88
LING ADDRESS
CITY. STATE. ZIP / (�
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CELL PHONE
( ) -
RELATTONSHIP TO PROJECT
❑ Architect ❑ Tenant ❑ Agent ther /
FAX NUMBER
(R53)79&
NAME
mames
PRIMARY PHONE
E -MAIL ADDIESS ( '
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
PROPOSED USE
VALUE OF PROPOSED WORK $ 27 o
SPRINKLERED BUILDING? KYES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? )ryES ❑ NO
WATER SERVICE PROVIDER > AKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) /�
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
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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
REFRIG. SYSTEMS
BASIC PLAN? o YES o NO
THIRD
CHANGE OF USE? o YES o NO
ADDITIONAL FLOORS (DESCRIBE)
o YES o NO
UP /SEPA /SU? o YES o NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
o YES o NO
DEMO PERMIT REQUIRED? o YES o NO
GARAGE ❑ CARPORT O
NUMBER OF FLOORS
EICI.STRIO
PROPOSED
TOTAL
MrAL ERLSTINO SF
TorAL PROPOSED SF
TOTAL SF
"NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
E FIXTURES
Indicate number of each type offUture to be installed or relocated as part of this project. Do not include existing fixtures to remain.
I Value of Mechanical Work $
(A COPY OF BID OR ESTIMATE MUST BE INCLUDED WITH APPLICATION]
MR HANDLING UNITS
EVAPORATIVE COOLERS
GAS PIPE OUTLETS WOODSTOVES
BBQS
FANS
GAS WATER HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (commerdap
COMPRESSORS
FURNACES
RANGES
DUCTS
GAS LOG SETS
REFRIG. SYSTEMS
PLUMBING
BATHTUBS (orn b /Shower Combo
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WATER HEATERS
HOSE BIBBS
LAVS (Bathroom SinkS)
URINALS MISC (Describe)
RAINWATER SYST
VACUUM BREAKERS
SHOWERS
WATER CLOSETS ffwa)
SINKS
WASHING MACHINES
SUMPS
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o NEW o ADDITION
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.
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.
SIGNATURE:
�
1
DATE (y 1
Property Owner and /or Authorized
Agent
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o NEW o ADDITION
o ALTERATION
o REPAIR o 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 kWandoutslPermit Application