08-103788aTY OF 'A
Federal Way'ec
COMMUMTYDEVEIAPMENTSERYfCES
PERMIT SF MF CO ME EL PL DE EN FP
AUG � 1 2008
33325 SOUTH • BOX 9718 � CATION
FEDERAL WAY, WA 98063 63 -9718
253 - 835 -2607• FAX 253 - 835 -2609
wwwAtuoffederaiwau.com pf FF0
The following is d info rmeR6 an incomplete application will not be accepted. Please print legibly (in ink) or type.
PROPERTY •• •
SITE ADDRESS A CJ S 1 '1 e 1 SUITE /UMT #
ASSESSOR'S TAX /PARCEL # � ° - (' � lc_ -L LOT SIZE (sf)
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1) L cn4 c; La) r1 1 JAS A
(Attach sep ate page for lengthy legal descriptlorl)
PROJECT INFORMATION
TYPE OF PERMIT ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING X FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
�i/ s i L °l Sira A)esr M "f 1 C..M
PROJECT NAME (Name of Business or Owner Last Namel C-0 rQL, C— JL, h o A GT�ti r
PEOPLE •• •
PROPERTY
OWNER
CONTRACTOR
O�
APPLICANT
PROJECT
CONTACT
LENDER
NAME
PRIMARY PHONE
MAILINgABORESS
0%C - �a �i
CITY, STATE. ZIP
aL
E -MAIL, ADDRESS
L .ia=a�
MAILING 4DDRESS CITY, STATE, ZIP CELL NE - S
Si. "! IU, \., ' Q& ( (CN )
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER MIRATiON DATE FAX NUMBER
2. —
c _ ��
NT 'S REGISTRATION R EXPIRATION DATE E -MAIL ADDRESS
V-1 v K Y m I r% .7'7 iZ %A I-) X - - ') tai Ae.- le n k-i rt,, a e1 eAA
❑ Architect v ❑ Tenant ❑ Agent It Other Lti,'�'1 f ,&L, f U-S-3) 1?%-,14 - 23�, �
cf't-
-tt"+
EXISTING USE PROPOSED USE / qq
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED? ❑ YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
Dim 1
PROJECT FLOOR AREAS
AREA DESCRIPTION
EXISTING
FT.
PROPOSED
S . FT.
TOTAL
S . FT.
BASEMENT
D ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
FIRST
D YES D NO
BASIC PLAN? D YES
SECOND
ZONING DESIGNATION
THIRD
D NO
NEW ADDRESS REQUIRED? DYES D NO
ADDITIONAL FLOORS (DESCRIBE)
D NO
PLATTED LOT? D YES D NO
DECK (❑ COVERED OR ❑ UNCOVERED ?)
D NO
GARAGE ❑ CARPORT ❑
NUMBER OF FLOORS
raorosm
73M
roracmm=osr
sr
roracsr
*"NEW HOMES O NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of
Value of Mechanical Work
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
offmture to be installed or relocated as part of this project. vo not inctuae
BATHTUBS (or Tub /Shower Combo)
DISHWASHERS
DRINKING FOUNTAINS
ELECTRIC WA ATER:
HOSE B
OF BID OR ESTIMATE MUST BE INCLUDED
EVAPORATIVE COOL,
FANS
FIREPLACE INSERTS
FURNACES
GAS LOG SETS
1J'kVJ (Bathroom Sinks)
RAINWATER SYST
SHOWERS
SINKS
SUMPS
3�OUTLETS
WATER HEATERS
HOODS (Commercial)
URINALS
VACUUM BREAKERS
WATER CLOSETS gofla)
WASHING MACHINES
APPLICATION)
w rernam.
WOODSTOVES
MISC (Describe)
MISC (Describe)
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, 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 put 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 thplicat' G
SIGNATURE: DATE
Owner and /or Authorized Agent
FOR OFFICE USE ONLY
D NEW D ADDITION
D ALTERATION
❑ REPAIR ❑ TENANT IMPROVEMENT
BUILDING SHELL ONLY?
D YES D NO
BASIC PLAN? D YES
❑ NO
ZONING DESIGNATION
CHANGE OF USE? D YES
D NO
NEW ADDRESS REQUIRED? DYES D NO
UP /SEPA /SU? D YES
D NO
PLATTED LOT? D YES D NO
DEMO PERMIT REQUIRED? ❑ YES
D NO
Bulletin #100 - January 1, 2008 Page 2 of 4 k\Handouts\Permit Application