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Federal Way RECD --� -_ --
PERMIT SF MF CO IEL PL DE E FP
COMMUNITY DEVELOPMENT SERVICES
3353ORRSTWAY
FEDERAL WAY, WA 8063 - -918 718 A p p LI C AT I O NI N 2 2 2
253 - 6614115• FAX 253-661-4129
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CITY OF FEDER)
The folloudnq is required information - an { .44= lete a licahon wi8ld(it
PROPERTY INFORMATION
SITE ADDRESS 33 S Ci 17-'7— F,
ASSESSOR'S TAX /PARCEL #
SUITE /UNIT #
LOT SIZE (sj)
or
LEGAL DESCRIPTION (e.g. Acme Estates, Lot 1)
(Attach sep—fn pagefor lengthy k9.1 d— iptionl
TYPE OF PERMIT ❑ BUILDING _
❑ DEMOLITION ❑ ELECTRICAL ❑ ENGINEERING�ZIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlu)
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PROJECT NAME (Name of Business or Owner Last Name �E §A ssa S
I INFORMATION
PROPERTY
OWNER
CONTRACTOR
APPLICANT
CONTACT
LENDER
EXISTING USE
N ME
NAME
MAILING ADDRESS
CITY, STATE, ZIP
PRIMARY PHONE
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MAILING ADDRESS
I z3c� S
43(:) S�,
CITY, STATE, ZIP
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COMPANY NAME
APPLICANT NAME
OFFICE PHONE
I�./L/ DSS
15-
CITY STATE, ZIP
c
VIZ
CELL PHONE
(2-06)679
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CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXVIRATION DATE
FAX NUMBER
— ---
— — — B
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CONTRACTOR5 REGISTRATION NUMBER (copy o[ card required with each application)
EXPIRATION DATE
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COMPANY NAME
AfAE
Can
APPLICANT NAME
OFFICE PHONE
( )
-
MAILING ADDRESS
CITY, STATE, ZIP
CELL PHONE
( )
RELATIONSHIP TO PROJECT
FAX NUMBER
❑ Architect
❑ Tenant ❑ Agent ❑ Other (Describe)
NAME
^^
PRIMARY PHONE
E -MAIL ADDRESS
Q
4
-
Per RCW 19.27.095_ Lender information is
required if project vatue exceeds' $5,000
NAME
MAILING ADDRESS
CITY, STATE, ZIP
EXISTING ASSESSED /APPRAISED VALUE $
DETAILED BUILDING INFORMATION
PROPOSED USE
VALUE OF PROPOSED WO
SPRINKLERED BUILDING? ❑ YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUI-li8 YES ❑ NO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
i
AREA DESCRIPTION
EXISTING S . FT.
PROPOSED S . FT.
TOTAL
BASEMENT
SUMPS
WASHING MACHINES
URINALS
FIRST
VACUUM BREAKERS
BASIC PLAN?
SECOND
o NO
ZONING DESIGNATION
NEW ADDRESS REQUIRED? o YES o NO
THIRD
a YES
o YES
o NO
o NO
PLATTED LOT? o YES a NO
FOURTH
DEMO PERMIT REQUIRED?
o YES
o NO
ADDITIONAL FLOORS (DESCRIBE)
DECK(COVERED ?)
GARAGE /CARPORT
HOW MANY FLOORS?
TOTAL cxisrmc
TOTAL PROPOSED
TOTAL EXISTING A1(D PROPOSED
* *NEWHOMES ONLY ** NUMBER OF BEDROOMS ESTIMATED SELLING PRICE $
Indicate number of ea e-of�ufttr
MEC.FIANICAL
Value of Mechanical k $ V (5 d
AIR HANDLING UNITS
BBQS
BOILERS
COMPRESSORS
DUCTS
be installed
EVAPORATIVE COOLERS
FANS
FIREPLACE INSERTS
FURNACES
GAS PIPE OUTLETS
BATHTUBS (orTub /Show Combo)
SHOWERS
DISHWASHERS
SINKS
GAS PIPE OUTLETS
SUMPS
WASHING MACHINES
URINALS
LAVS iBad— siilksi
VACUUM BREAKERS
as part of this project. Do not include existing fixtures to remain.
GAS LOGS
HOODS (co—mia )
RANGES
GAS WATER HEATERS
REFRIG. SYSTEMS
WOODSTOVES
MISS (Describe)
3 1l! Z
_ WATER CLOSETS Iroa<q SC (Describe)
_ DRINKING FOUNTAINS
RAINWATER SYST
_ HOSE BIBBS
ELECTRIC WATER HEATERS
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge, and further, that I
am authorized 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, 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 of Federal Way, 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.
NAME /TITLE
(Signature) (Title)
RELATIONSHIP TO PROJECT ❑ Owner ❑ Agent ❑ Contractor ❑ Architect ❑
FOR OFFICE USE ONLY
a 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
NEW ADDRESS REQUIRED? o YES o NO
CHANGE OF USE? ': ., '
UP /SEPA /SU? r Itas 9
a YES
o YES
o NO
o NO
PLATTED LOT? o YES a NO
DEMO PERMIT REQUIRED?
o YES
o NO
QUlletin H 100` 4 Maich:3_0.,2004
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k \( {andouts – Revised \Permit Applic