07-100230J, Feder way :'
CQMW?gTYDEVELQPMENTSERYICES��c0 PERMIT F F 0 ME IDL PL DE :EN FP
333 ?5'DEMWA SOUTH A 98 Po97X97 PPLI�CATI O N
• NEDERAL WAY, WA 98063.971d A
.253.835-2607- FAX 2S3- 835-2609 I
www.dl*- Wkdemhony.com JAN 1 2
The following is required information} �,p�ncomplete application will not be accepted. Please print legibly (in ink) or. type.
- ~ry n� "DERA11 YYi�1
SITE ADDRESS V �`� �jr1�' Q- SUITE /UNIT #
ASSESSOR'S TAX /PARCEL N Q . y.Pr," 2 c) - Q t LOT: SIZE (s• )
LEGAL DESCRIPTION (e.g. Acme Estates, Lot
f UNA iep- -paraft -leap ft I vol deevOko )
PROJECT •, •
TYPE OF PERMIT UILDING 0 PLUMBING D MECHANICAL
O DEMOLITION 0 ELECTRICAL O ENQINEERING. 0: FIRER PRE[%ENTION SYSTEM
PROJECT DESCRIPTION. (nhovide detailed description of work included .on this permit only) '
n__ n
PROJECT. NAME (Name of Business or Owner Lasf Namel
PEOPLE Inlif
•- •
PROPERTY NAME --�-{ q�`►
OWNER 1 I� ,-�- ( AMY PI�o,►�e
NO ADDRESS CITY, STATE, ZIP E -MAIL ADDRAss
1O 1pi
CONTRACTOR
COPY at card required
with eeeh,epplication
APPLICANT
PROJECT
CONTACT
LENDER
CO1+�ANY N� � APPLICANT NAAM O
OFFICE QPHONE
:
:MTAIAD� J CITY, ST AT , ZAP _ �. C
CE_ LL PHONE
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER EXPIRATION DATE F
FAX NUMBER
CONTRACTORS REGISTRATION NUMBER EXPIRATION DATE E
E-MAIL ADDRESS
00C PH 1
MAILING ADDRESS` CITY, STATE, ZIP 1 C O • ,� i ,
RELATIONSHIP TO PROJECT FAX NUMBER • ,v JJ
o Architect o Tenant o Agent Other ( YI� )o4
L
17nol i ` I tr l� !l. PR PH . tJti - o 0 _•'i � mminif- 0t I o I
NAME Air RCW 19,27.095:
Lender information is required i f project value exceeds $5,000
MAILING ADDRESS CTTY, STATE, ZIP /PHONE '
EXISTING USE PROPOSED USE
EXISTING ASSESSED(APPRAISED VALUE $ -VALUE OF PROPOSED WORK $_ I , 3 50
SPRINKLERED BUILDING? ' " o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRLD? o YES o NO
WATER SERVICE PROVIDER D LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
$EWER SERVICE PROVIDER o LAKEHAVEN 13 HIGHLINE 0 PRIVATE (SEPTIC)
L
17nol i ` I tr l� !l. PR PH . tJti - o 0 _•'i � mminif- 0t I o I
NAME Air RCW 19,27.095:
Lender information is required i f project value exceeds $5,000
MAILING ADDRESS CTTY, STATE, ZIP /PHONE '
EXISTING USE PROPOSED USE
EXISTING ASSESSED(APPRAISED VALUE $ -VALUE OF PROPOSED WORK $_ I , 3 50
SPRINKLERED BUILDING? ' " o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRLD? o YES o NO
WATER SERVICE PROVIDER D LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
$EWER SERVICE PROVIDER o LAKEHAVEN 13 HIGHLINE 0 PRIVATE (SEPTIC)
EXISTING USE PROPOSED USE
EXISTING ASSESSED(APPRAISED VALUE $ -VALUE OF PROPOSED WORK $_ I , 3 50
SPRINKLERED BUILDING? ' " o YES o NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRLD? o YES o NO
WATER SERVICE PROVIDER D LAKEHAVEN o HIGHLINE o TACOMA o PRIVATE (WELL)
$EWER SERVICE PROVIDER o LAKEHAVEN 13 HIGHLINE 0 PRIVATE (SEPTIC)
AREA DESCRIW EXISTING :'PROPOSED TOTAL
S ; FT: S . FT.
BASEMENT
FIRST
SECOND
THIRD
TTTA1d AT WTtnnvQ_1FvQFv7nv1
NUMBER OF FLOORS
" *NEW HOMES ONLY" NUMBER OF BEDROOMS ESTIMATE ELLING PRICE $
Indicate number of each type of fixture to be installed oX,,,cat!d
art of this project.. Do, not include existing fixtures to remain:
MECNAMCAL
o TENANT IMPROVEMENT.
Value of Mechanical Work $
(A OF BID -OR ES77MATE ST BE INCLUDED WITH APPLICATION)
AIR HANDLING UNITS
APORA71VE COOLERS
OA PE OUTLETS WOODSTOVES
BBQS
FANS
(iA8 W R HEATERS MISC (Describe)
BOILERS
FIREPLACE INSERTS
HOODS (c adtt
COMPRESSORS
FURNACES
RANGES "
DX
LOO SETS
REFRIG. SYSTEM
a NO
PLATTED LOT?
o YES o NO
PLUMBWO
DEMO PERMIT REQUIRED?
o YES
BATHTUBS for Tub /Shower combo)
LAVS )aitlu"msinks)
URINALS IHISC (Describe)
DISHWASHERS
RAINWATER SYST
VACUUM BREAKERS
DRINKING FOUNTAINS
SHOWERS
WATER CLOSETS rroikq
ELECTRIC WATER HEATERS
SINKS
WASHING MACHINES
HOSE BIBBS
SUMPS
I cert(fy under•.penaity of perjury that the information furnished by ms is true 'and correct to the best of my knowledge, and further, that I
am authorised by the owner of the above premises to perform the work for which the permit application is made. I further agree to hold
harmless the City of Federal Way as to any claim /including costs, axpeosea, and attorneys' fees incurred in the investigation and defense of
such claim), which may be made by any person, including the undersigned, and jlied.against the City of Federal Way, but only where such claim
arises out of the reliance ojthe city, tncl ing its officers and employees, upon the accuracy of the information supplied to the city as a part of
this applica n.
NAME /TITL — " °A � � — b�
(Signs rnue) '
RELATIONS T PROJECT a Owner o Agent 4�Cmtractor O Architect D Other
o NEW o ADDITION
o ALTERATION
o REPAIR
o TENANT IMPROVEMENT.
BUILDING SHELL ONLY?
o YES ONO
BASIC PLAN?
o YES
o NO
ZONING DESIGNATION
CHANGE OF USE?
o YES
ONO
NEW ADDRESS REQUIRED?
o YES o NO
UP /SEPA /SU?
a YES
a NO
PLATTED LOT?
o YES o NO
DEMO PERMIT REQUIRED?
o YES
o NO
Bulletin 19100 — January 1, 2007 Page 2 of 4 k andoutAPermit Application .