06-105856RECEIVED
Feder�allWay NOV 3 zoo�EP.MIT APPLICATION
11
For Office Use Only
The following is required information - an incomplete application will not be
Please
COMMUN17Y DEVELOPMENT SERVICES
33530 FIRST WAY SOUTH • PO BOX 9718
FEDERAL WAY, WA 98063 -9718
253-66141 IS- FAX- 253- 661 -4129
www ciWOf ederalwau com
SITE ADDRESS: q +S 3 (i t 1 SUITE /APT # n 1 C
ASSESSOR'S TAX /PARCEL it: G +7 y z S - Ci 0 , SQUARE FOOTAGE OF LOT- �' I- 3 0 q
LEGAL DESCRIPTION (e.g.: Acme Estates, Lot 1) {,�,: SC+ E.' h y 1% Fee l+ll-i W�`tl ClO3S i �+4 S
(Atiach separate p ge for lengthy legal description)
PROJECT r •- I: •
TYPE OF PERMIT (This application): ❑ BUILDING ❑ PLUMBING ❑ MECHANICAL ❑ DEMOLITION
❑ ELECTRICAL ❑ ENGINEERINGW FIRE PREVENTION SYSTEM
PROJECT DESCRIPTION (Provide detailed description of work included on this permit onlul:
69 'P4rP_ sb1'1A1f1 '.- �►�.v �`A l: �.ile _
PROJECT NAME (Name of Business /Owner Last Name):
PROPERTY
OWNER
CONTRACTOR
LENDER
(If Proposed V.I.. > $5,0001
APPLICANT:
NAME:
Tv,, Fedc�n_
W111
PRIMARY PHONE:
= "r1 w
EVENING PH�fONE:
RELATIONSHIP TO PROJECT; 42 pp }
❑Architect ❑Tenant Other (Describe) .� (J:� - 'i) oz7JV�
FAX NUMBER:
(✓Sr3 ) 18�- - SJ7
MAILING ADDRESS (STREET ADDRESS.;):
L�o 671 i0A
CITY, STATE, ZIP
P cal -r- WA tee 4
NAME /
��'f5111�
COMPANY (�
jf/28 rq
OFFICE PHONE::
v
f�';rQO f,r A.
MAILING ADDRESS (STREET ADDRESS;):
r�
CITY, STATE, ZIP
,` y g
CELL PHONE:
(253 ) 46S
-7 q-s-
�z �-
CITY OF FEDERAL WAY BUSINESS LICENSE NUMBER
EXPIRATION DATE:
FAX NUMBER
1_-
12 / ]S
(Zs-3 )2 ?j-
- 31�P?
CONTRACTOR'S REGISTRATION NUMBER:
I
r
�.
IEXPIRATION
{ V / s i
DATE:
(copy of card required with each application) l�
{
NAME: DAYTIME PHONE:
/114 ( ) -
MAILING ADDRESS (STREET ADDRESS;): CITY, STATE, ZIP
NAME'�
COMPANY
OFFICE PHONE:
MAILIIN}G ADDRESS (STREET ADDRESS): _
CITY, STATE, ZIP p
EVENING PH�fONE:
RELATIONSHIP TO PROJECT; 42 pp }
❑Architect ❑Tenant Other (Describe) .� (J:� - 'i) oz7JV�
FAX NUMBER:
(✓Sr3 ) 18�- - SJ7
ICONTACT PERSON FOR THIS PROJECT: ❑ Property Owner ❑ Contractor pplicant
DETAILED BUILDING INFORMTION
�...�IrrS•�- tee.,, �(`� /Jc�- 6,If'�I`r�
ZXISTING USE: 1!"G..+ 1�i 1 PROPOSED USE: 1 ' w`-g 5 s -g e 1 YFaTlneti, l .
EXISTING ASSESSED /APPRAISED VALUE $ VALUE OF PROPOSED WORK: $
SPRINKLERED BUILDING? /YES ❑ NO FIRE SUPPRESSION SYSTEM PROPOSED /REQUIRED ?: ❑ YES JR-RO
WATER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ TACOMA ❑ PRIVATE (WELL)
SEWER SERVICE PROVIDER ❑ LAKEHAVEN ❑ HIGHLINE ❑ PRIVATE (SEPTIC)
■ PROJECT FLOOR AREAS mm
AREA DESCRIPTIONS
EXISTING S • .. FT.
PROPO D S . FT. TOTAL
BASEMENT
SINKS
DRINKING FOUNTAINS
'
FIRST
RAINWATER SYS
WASHING MACHINES
2-
SECOND
GAS LOGS
REFRIG. SYSTEMS
BBQS
.THIRD
HOODS (comet< w)
WOODSTOVES
BOILERS
FOURTH
--�
MISC (Describe)
_COMPRESSORS
ADDITIONAL FLOORS (DESCRIBE)
GAS WATER HEATERS
❑ YES a NO
DUCTS
DECK .(CO VERED ?)
o'YES
0 N
GARAGE /CARPORT
HOW MANY FLOORS?
TOTAL P.%I.S79NG-
TOTAL PROPOSED
TOTAL EXISTING AND PROPOSED
J
* *NEWHOMES ONLY ** NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
Indicate number of each type of fixture that is to be installed or relocated as part of this project. Do not include
existing fixtures to remain.
MECSAMCAL
DISHWASHERS
SINKS
DRINKING FOUNTAINS
Value of Mechanical, Work $
SUMPS
RAINWATER SYS
WASHING MACHINES
-AIR HANDLING UNITS
EVAPORATIVE COOLERS
GAS LOGS
REFRIG. SYSTEMS
BBQS
FANS
HOODS (comet< w)
WOODSTOVES
BOILERS
FIREPLACE INSERTS
RANGES
MISC (Describe)
_COMPRESSORS
FURNACES
GAS WATER HEATERS
❑ YES a NO
DUCTS
GAS PIPE OUTLETS
o'YES
0 N
PLUMBING
BATHTUBS (orrub/Sno— Combo)
SHOWERS
WATER CLOSETS Iroa<q MISC (Describe)
DISHWASHERS
SINKS
DRINKING FOUNTAINS
GAS PIPE OUTLETS
SUMPS
RAINWATER SYS
WASHING MACHINES
URINALS
HOSE BIBBS
LAVS (Bathroom Sink
VACUUM BREAKERS
ELECTRIC WATER HEATERS
]TSCLATMRR /STGNATIIRR RT.C'.
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 apart of this application.
NAME /TITLE: DATE: ` 7 —01
RELATIONSHIP TO PROJECT: ❑ Property Owner ❑ Applicant E'Contractor ❑ Architect ❑
6 ADDITION
o ALTERATION
o REPAIR o TENANT IMPROVEMENT
x SHELL;ONLY?
.;
a;YES. q N0
BASIC PLAN? .
❑YES
a.,NO .
-.. ..
)ESIGNATION.
CHANGE OF USE? ' :,:
o YES
❑ NO
MESS -REQUIRED?
o YES ❑ NO
UP /SEPA /SU?
❑ YES
❑ NO r
LOT?
❑ YES a NO
DEMO PERMIT REQUIRED ?.
o'YES
0 N
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