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08-102569ertros — �S.L� Fe IwalkECE YY p "APPLICATION E R M I T SF F CO ME EL PL 3- L DE EN CDMMUN/TYDEVELOPMBNTSERVICES MAY (� 33325 Sw SOUTH • PO BOX 9718 LD FEDE RILWAY, WA 98063 -9718 253-835 -2607• FAX 253.835 -2609 ©F FEDERAL WAY The following is required Intn5on - an incomplete application will not be accep ase print legibly (in ink) or type. ASSESSOR'S TAX /PARCEL # 2- ! ? w LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) ST 12-CE7 CQ 2= j PROJECT INFORMATION SUITE /UNIT LOT SIZE (sfi TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING fFIRE PREVENTION SYSTEM PROJECT DESCRIPTION /Provide detailed de- arrintinn of vrnrk inrhrdoA nn this normit nnlvl PROJECT NAME (Name of Business or Owner Last Name) PROPERTY OWNER NAME (� G l n G` kID�z1 t- , L C� PRIMARY PHONE ( 6) 9 y7 1 V ¢ AD 5 ' (i P'G 'E At ;r MAILING ADDRESS yy � Q 119 /V� . �' I CITY, STATE, ZIP 136tLGV(4& jUA i�li E-MAIL ADDRESS L Ejrac�l�ofsavl evJ- {'(i��bT` CONTRACTOR APPLICANT PROJECT CONTACT LENDER COMPANY s n4' 2�i C APPLICANT NAME OFFICE ) Z 4 _ N kC) 1 V ¢ AD 5 ' (i P'G 'E At ;r CITY. I / 7 Co W A- yv rr CELL PHONE - CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER S►�(�f5136( EXPIRATION DATE 11-2- OP FAX NUMBER QS-3 )W6 _.. CONTRA 'e it ON R07a8SR w 497 —000055 a k EXPDRATION DATE (ze,60) E-MAIL ADDRESS COMPANY NAME APPLICANT NAME 89A e� �.. J OFFICE PHONE (206) 9Y> -9N16 MAILING ADD ` l /ii 1= I CITY, STATE, ZIP l fiZ e _ . CELL PHONE - RELATIONSHIP TO PROJECT ❑ Architect ❑ Tenant ❑ Agent `W�Other 0 L.J N V-- FAX NUMBER ( ) - NAME PRIMARY PHONE E T-- - MAIL ADDRESS NAME `, Per RCW 19.27.095. Lender ir{formallon is required ij'project value exceeds $5,000 MAILINO ADDRESS CITY, STATE, ZIP PHONE C( (98;9) 2DD- - EXISTING USE PROPOSED USE C (' EXISTING ASSESSED /APPRAISED VALUE VALUE OF PROPOSED WORK $ J J SPRINKLERED BUILDING? O YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED? ❑ YES ❑ NO WATER SERVICE PROVIDER ❑ LAKEI.IAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL) SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC) nei r AREA DESCRIPTION EXISTING 8 . FT. PROPOSED S . FT. TOTAL S . FT. BASEMENT FIREPLACE INSERTS COMPRESSO FURNACES FIRST GAS LOG SETS G MISC (Describe) SECOND LAVS (Bsftwm Skd* DISHWASHERS RAINWATER SYST THIRD SHOWERS ELECTRIC WATER HEATERS SINKS ADDITIONAL FLOORS (DESCRIBE) SUMPS DEMO PERMIT REQUIRED? o YES o NO DECK (❑ COVERED OR UNCOVERED ?) GARAGE ❑ CARPORT ❑ NUMBER OF FLOORS riwrosso TOTAL TOTALSasrrnw Or TOTAL rBOPOe6O er TOTAL el "NEW HOMES ONLY*" NUMBER OF BED MS ESTIMATED SELLING PRICE $ Indicate number of each type of fixluryfo be installed or Value of Mechanical Work $,�1 (A COPY OF BID OR AIR HANDLING UNITS EVAPORATIVE COOLERS BBQS FANS BOILERS FIREPLACE INSERTS COMPRESSO FURNACES DUCTS GAS LOG SETS G MISC (Describe) $ (orTub /Sharer Combo( LAVS (Bsftwm Skd* DISHWASHERS RAINWATER SYST DRINKING FOUNTAINS SHOWERS ELECTRIC WATER HEATERS SINKS HOSE BIBBS SUMPS as part of this project. Do not include existing fixtures to remain. MUST BE INCLUDED WITH APPLICATION) AS PIPE OUTLETS WOODSTOVES GA ATER HEATERS MISC (Describe) HOODS( o YES o NO RANGES BASIC PLAN? a.YES REFRIG. SYSTEMS ZONING DESIGNATION URINALS MISC (Describe) VACUUM BREAKERS o NO WATER CLOSETS (ToBeq o YES o NO WASHING MACHINES . UP /SEPA /SU? o YES I ea t(& under penalty of perjury that 1 am the property owner or authorised agent of the property owner. I certify that to the best qj my knowledge, the igformation submitted in support of this permit application is true and correct. I certify that t will comply with all applicable City of Federal Way regulations pertaining to the work authorised 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. 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 U of fhe city, including its offleers and employees, upon the accuracy of the information supplied to the city as a part o f thi, app o SIGNATURE: Owner o NEW o ADDITION o ALTERATION o REPAIR q TENANT IMPROVEMENT BUILDING SEMLL ONLY? o YES o NO BASIC PLAN? a.YES a NO ZONING DESIGNATION CEIANGE 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 k\Handouts\Permit Application